CONNECTICUT DEPARTMENT OF PUBLIC HEALTH PUBLIC HEALTH INITIATIVES BRANCH COMMUNITY HEALTH AND PREVENTION SECTION Connecticut State Plan for Program Operation of the Special Supplemental Nutrition Program For WOMEN, INFANTS, AND CHILDREN (WIC) Federal Fiscal Year 2013 (October 1, 2012 – September 30, 2013) Submitted in accordance with USDA Food and Nutrition Service Federal Regulations 246.4(A) - State Plan August 10, 2012 CT WIC State Plan FY2013 TABLE OF CONTENTS PART I A. Introduction………………………………………………………………………………………….1 B. Mission Statements……………………………………………………………………………….2 C. State Agency Organization…………………………………………………………………….3 D. Local Agency Organization…………………………………………………………………….8 E. PROGRESS FFY 2012 Goals and Objectives ………………………….……………10 F. FFY 2013 Goals and Objectives……………………………………………………………45 CT WIC State Plan FY2013 A. INTRODUCTION The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is implemented by the United States Department of Agriculture (USDA-FNS) under public law 95-627, Section 17 of the Child Nutrition Act of 1966; final regulations were issued January 2002. Funds for Food and Administrative costs are transferred from USDA – FNS to the Connecticut Department of Public Health, Public Health Initiatives Branch, Community Health and Prevention Section. The State Plan for Connecticut’s Women, Infants and Children (WIC) Program is the governing document that provides guidance and direction for the state and local agencies administering the program. In compliance with Federal regulations and State regulations and requirements, the plan is updated annually to ensure the inclusion of new and revised federal and state requirements, miscellaneous rules etc. Although the Plan is primarily based on Federal regulations, it is includes requirements and guiding principles for best practices from the state perspective and that of the nation’s public health framework. Although the State WIC Plan references a single document, it has 3 major components. Part I of the plan contains the State goals and objectives FFY2013 and the evaluation FFY2012. To the extent possible, the goals address the core functional areas of the WIC Program. These functional areas are: management and organization, nutrition services and breastfeeding support and promotion, food delivery and food instrument accountability, vendor management, management information systems, caseload management and outreach, coordination of services, civil rights, certification and eligibility, monitoring and QA, fiscal management and data quality, analysis and reporting. The goals and objectives are State-specific and function as a guide for enhancing both State and local program operations effectiveness and efficiency. The remaining VENA Implementation Plan tasks are 90% completed. Those remaining tasks will be integrated into relevant functional areas to ensure the sustainability of the VENA concept. Approximately $52 million is allocated to CT WIC for Food and Administration and an additional $12 million rebated by Mead Johnson Nutrition, through a cost savings measure as part of the infant formula rebate program. CT WIC State Plan FY2013 1 B. MISSION STATEMENTS DPH Mission: To protect and improve the health and safety of the people of Connecticut by: • Assuring the conditions in which people can be healthy; • Promoting physical and mental health, and • Preventing disease, injury, and disability. DPH Vision Statement: Healthy People in Healthy Connecticut Communities. CHAPS Section Mission: Community Health and Prevention section is a positive and productive section of the CT Department of Public Health that creates and achieves optimal public health outcomes through strong, consistent, proactive and ethical leadership; a positive and productive workplace environment; results-based accountability, and premier customer friendly service to the public by valued employees through technical assistance, best-practice and research-based expertise, and clear and accurate communication. WIC Program Mission: The Connecticut WIC Program is committed to improving the health of eligible pregnant women, new mothers, and children by providing nutrition education, breastfeeding support, healthy foods, and referrals to health and social programs during the critical stages of fetal and early childhood development. We do that by giving our most vulnerable children the best possible start by providing optimal nutrition during the critical stages of fetal and early childhood development phases. Breastfeeding Statement: The Connecticut WIC Program endorses the American Academy of Pediatrics' Policy Statement on “Breastfeeding and the Use of Human Milk” (2005), which states, “Exclusive breastfeeding is the reference or normative model against which all alternative feeding methods must be measured with regard to growth, health, development, and all other short-and long-term outcomes.” Connecticut Special Supplemental Nutrition Program for Women, Infants and Children (WIC) promotes exclusive breastfeeding as the normal infant feeding method through the first year of life and beyond, with the addition of appropriate complementary foods when the infant is developmentally ready, usually around six months of age. All WIC staff have a role in promoting and providing support for the successful initiation and continuation of breastfeeding. CT WIC State Plan FY2013 2 C. STATE AGENCY ORGANIZATION Public Health Initiatives Branch Community Health and Prevention Section Special Supplemental Nutrition Program for Woman, Infants and Children (WIC) Administrative Organization Chart John Frassinelli State WIC Director Vacant Associate Accountant Stacy Nelson Secretary 1 Kimberly Boulette Health Program Associate Kevin Krusz Health Program Assistant 2 Olga Jimenez Processing Technician Antonia DiGrazia Health Program Assistant 2 Marjorie Chambers Nutrition Consultant 2 Carol Castro Health Program Assistant 2 Maureen Wojtczak Nutrition Consultant 2 Marangelie Ortiz Health Services Worker Marilyn Lonczak Nutrition Consultant 2 Steven Hotchkiss Hea;th Program Assistant 1 Amanda Moore Nutrition Consultant 2 Elsa Arce Health Service Worker Caroline Cooke Nutrition Consultant 1 Barbara Quiros Health Service Worker Luis Maldonado Office Assistant INFORMATION TECHNOLOGY FINANCIAL MANAGEMENT (Operations Branch ) (Administrative Branch) Thomas Young Technical Analyst 2 Daniel Fuller Technical Analyst 2 Kirk Whalley Technical Analyst 2 CHAPS EPI Unit (PHI Branch) Minerva Sisco Fiscal Administrative Officer Justin Peng EPI - 4 Mary Funari Associate Accountant Susan Hewes EPI - 3 CT WIC State Plan FY2013 3 D. STATE AGENCY ORGANIZATION STAFF M EM B ER P RI M ARY R ESP ONSI BI LI TES John Frassinelli, MS, RD State WIC Director T: (860) 509-7836 F: (860) 509-8391 E-mail: [email protected] Federal grants management Contracts and budgets WIC program policy Program planning and evaluation Program management & administration Certification and eligibility Nutrition Services MIS & Fiscal units oversight Amanda Moore, RD Nutrition Consultant 2 T: (860) 509-8055 F: (860) 509-8391 E-mail: [email protected] Nutrition Services and Certification Reviews Issue written reports/respond to corrective action Provide technical assistance Update/provide input on Local Agency plan and State Plan Polices Marilyn Lonczak, MEd, RD Special Projects T: (860) 509-8261 F: (860) 509-8391 E-mail: [email protected] Breastfeeding Promotion and Support State Plan Local staff training and technical assistance Ensure quality breastfeeding and nutrition services Nutrition Risk Criteria (back-up) on RISC Caroline Cooke, RD, CLC Nutrition Consultant I T: (860) 509-7138 F: (860) 509-8391 E-mail: [email protected] Breastfeeding Promotion and Support Breastfeeding councils and coalitions Breastfeeding program planning and evaluation Local staff training and technical assistance Marjorie Chambers, MS, RD Nutrition Services Monitor T: (860) 509-8101 F: (860) 509-8391 E-mail: [email protected] Review Program Monitors written reports and response to corrective action Lead Liaison for Local WIC Agencies Conduct grant management activities such as the development of request for proposals (RFP) Provide technical assistance Update/provide input on Local Agency plan and State Plan Polices Develop new food packages Maureen Wojtczak, MS, RD Nutrition Education Specialist T: (860) 509-8091 F: (860) 509-8391 E-mail: [email protected] Nutrition Risk Criteria LA Technical Assistance Nutrition education Formula issuance Antonia DiGrazia, BA Program Monitor T: (860) 509-7684 F: (860) 509-8391 E-mail: [email protected] Management Evaluation Reviews Caseload management Complaints/customer service Civil rights CT WIC State Plan FY2013 4 STATE AGENCY ORGANIZATION cont’d Carol Castro Health Program Assistant 2 T: (860) 509-7187 F: (860) 509-8391 E-mail: [email protected] Web content State Plan update WIC Materials management Contract liaison Training Evaluation Complaints/customer service Special Formula Reconciliation Marangelie Ortiz Health Services Worker T: (860) 509-8084 F: (860) 509-8391 E-mail: [email protected] Field work Steven Hotchkiss Health Program Assistant 1 T: (860) 509-8084 F: (860) 509-8391 E-mail: [email protected] Vendor monitoring Program services Elsa Arce Health Services Worker T: (860) 509-7814 F: (860) 509-8391 E-mail: [email protected] Check reimbursements Special Formula orders Vendor Customer Service Barbara Quiros Health Services Worker T: (860) 509-8084 F: (860) 509-8391 E-mail: [email protected] Field Work Kimberly Boulette Vendor Specialist T: (860) 509-7845 F: (860) 509-8391 E-mail: [email protected] Food package implementation lead Vendor compliance investigations Development & maintenance of Food list The Integrity Profile Report Vendor Advisory Council lead Administrative Review Process Kevin Krusz Vendor Monitor T: (860) 509-8090 F: (860) 509-8391 E-mail: [email protected] Vendor Monitoring Vendor training Wholesale/Distributor liaison Coordination of formula availability in stores Mariano Ortiz Vendor Monitor T: (860) 509-8090 F: (860) 509-8391 E-mail: [email protected] Vendor Monitoring Track review process CT WIC State Plan FY2013 5 STATE AGENCY ORGANIZATION cont’d Claudio Santoro Vendor Monitor T: (860) 509-8090 F: (860) 509-8391 E-mail: [email protected] Vendor Monitoring Above 50% store determinations/reporting Inventory Audits Follow up on lost and stolen checks Olga Jimenez Processing Technician T: (860) 509-8072 F: (860) 509-8391 E-mail: [email protected] Vendor application processing Price Stock Survey updates Vendor correspondence/notification Susan Hewes Epidemiologist T: (860) 509-7795 F: (860) 509-8391 E-mail: [email protected] Outcome objective analysis Program Data analysis Produce results for quarterly objectives Internal/External data requests Stacy Nelson Secretary T: (860) 509-7841 F: (860) 509-8391 E-mail: [email protected] State staff support Customer Service Order and maintain supplies Timekeeper Meeting minutes Luis Maldonado Office Assistant T: (860) 509-7755 F: (860) 509-8391 E-mail: [email protected] Purchase requisitions Price Stock Survey Clerical Support Thomas Young Technical Analyst T: (860) 509-7841 F: (860) 509-8391 E-mail: [email protected] Systems development lead SWIS maintenance and enhancements Local Agency technical support SWIS data requests Daniel Fuller Technical Analyst T: (860) 509-7841 F: (860) 509-8391 E-mail: [email protected] Help Desk/Technical Support Equipment Prep/Deployment/Inventory Hardware Maintenance/SWIS update Hardware/Software Purchase Kirk Whalley Technical Analyst T: (860) 509-7841 F: (860) 509-8391 E-mail: [email protected] Mainframe Lead: Development & maintenance Cost containment & monitoring Security & Disaster recovery FoxPro developer backup Help Desk CT WIC State Plan FY2013 6 STATE AGENCY ORGANIZATION cont’d Mary K. Funari Associate Accountant T: (860) 509-7763 F: (860) 509-7227 E-mail: [email protected] Financial Management of WIC grant Food Cost Estimation Review and monitor funding levels Organize and maintain Budget Project expenditures for budgets and reporting purposes Work with other agencies to ensure accuracy of our transactions Work with auditors and program to ensure information reported is correct Monthly 798 report for USDA Reconcile bank and treasurer accounts Monitor Local Agency cash flow and disbursements Monitor Local Agency expenses for accuracy and compliance Minerva Sisco Fiscal Administrative Officer T: (860) 509-7713 F: (860) 509-8391 E-mail: [email protected] Bank reconciliation & Treasury Report Beechnut & Mead Johnson rebates Local agencies and Breastfeeding EBT report 425 CT WIC State Plan FY2013 7 D. Local Agency Organization LOCAL AGEN CY P ROGRAM COOR DI NATOR P ROGRAM NUTRI TI ONI ST The Access Agency, Inc. WIC Program 1315 Main Street, Suite 2 Willimantic, CT 06226 (860) 450-7405 [email protected] Karen Lechene Patricia Gaenzler Optimus Health Care Bridgeport WIC Program 1450 Barnum Avenue Bridgeport, CT 06610 (203) 333-9200 [email protected] Bristol Hospital WIC Program 9 Prospect Street Bristol, CT 06010 (860) 585-3280 [email protected] Verletha Santiago Marla Cofrancesco Melissa Dickau Pamela Beaulieu Danbury Health Department WIC Program 13 Main Street Danbury, CT 06810 (203) 797-4629 [email protected] Patricia Mascoli Ann Marie Evans East Hartford Health Department WIC Program 754 Main Street East Hartford, CT 06108 (860) 291-7323 [email protected] Family Strides, Inc. WIC Program 350 Main Street, Suite C Torrington, CT 06790 (860) 489-1138 [email protected] Kathy Minicucci Bina Patel Nicole Laracuente (Acting) Kristen Vilardi Hartford Health Department WIC Program 131 Coventry Street Hartford, CT 06112 (860) 757-4780 [email protected] Devone Edwards Danielle Smiley 8 CT WIC State Plan FY2013 Local Agency Organization cont’d Meriden Health Department WIC Program 165 Miller Street Meriden, CT 06450 (203) 630-4245 [email protected] Patricia Sullivan Shelley Carpenter New Haven WIC Program Hospital of Saint Raphael 1401 Chapel Street New Haven, CT 06511 (203) 789-3563 [email protected] Mary Chervenak Jennifer Gemmell Stamford Health Department WIC Program 888 Washington Boulevard Stamford, CT 06904 (203) 977-4385 [email protected] Rona Marotta Gloria Kelley Thames Valley Council for Community Action (TVCCA) WIC Program 83 Huntington Street New London, CT 06320 (860) 425-6620 [email protected] Sarah Drake Amy Botello Waterbury Health Department WIC Program 1 Jefferson Square, 1st Floor Waterbury, CT 06706 (203) 574-6785 [email protected] Kara Vendetti Michael Dessalines CT WIC State Plan FY2013 9 PROGRESS ON FFY 2012 GOALS AND OBJECTIVES CT WIC State Plan FY2013 Program Functional Area 1: Management and Organization Goal 1: Ensure program integrity, cost-effectiveness, quality of services and accountability in the delivery of nutrition services in the provision of food benefits. Objective 1.1: Implement a Memorandum of Understanding (MOU) with the State Department of Social Services (DSS) and Medicaid/Managed Care Providers to provide cross referrals and seamless and consistent services to WIC clients. Objective 1.2: Implement a Memorandum of Understanding (MOU) with the State Department of Children and Families (DCF) that addresses sharing of information between agencies. Objective 1.3: Refine and modify the CT WIC Annual Report by March 30, 2012. Objective 1.4: Provide a 1-2 day leadership and management workshop for LA Coordinators/Program Nutritionists/SA staff. Objective 1.5: Review, update and enhance WIC Continuity of Operations/Disaster Preparedness Plan Objective 1.1 Implement a Memorandum of Understanding (MOU) with the State Department of Social Services (DSS) and Medicaid/Managed Care Providers to provide cross referrals and seamless and consistent services to WIC clients. Strategies/Activities Develop priorities and strategize multi-prong approach regarding WIC business case. • Attend face-to-face meetings. • Identify specific liaisons from Connecticut’s Medicaid Program HUSKY and WIC • Develop a customized information packet. • Identify best practice collaborations at local agencies • Evaluate cross referral process and 1.2 Implement a Memorandum of Understanding (MOU) with the State Department of Children and Families (DCF) that addresses sharing of information between agencies. • Establish workgroup of agency representatives. • Develop an understanding of each agency’s requirements. • Develop MOU language and execute the agreements. • Provide training to State and local agency staff. CT WIC State Plan FY2013 Baseline N/A Indicators Executed MOU and evidence of enhanced cross referral between WIC and HUSKY Progress An amendment to the Department’s standing MOU with DSS has been transmitted to DSS liaison, appending WIC’s request for Medicaid data to help facilitate the cross-referral of clients for co-enrollment. Currently pending DSS response. Study carried out linking birthMedicaid-WIC records to determine baseline co-enrollment; results presented to colleagues, Local Agency staff and the Department’s Commissioners. N/A Executed MOU Local and State Agency understanding of procedures In process. Management staff continues to meet with DCF to clarify language for MOU. In FY 2013, necessary training and technical assistance will be provided to the local agencies. 10 1.3 Refine and modify the CT WIC Annual Report by March 30, 2012. Coordinate end of the year reports with local agency outcomes measures for FFY2011 • Report enhanced data on statewide measures • Share human interest stories highlighting how WIC benefits participants • Incorporate operational information on WIC to outside entities • Produce, distribute & post on WIC website. N/A Annual report is published and distributed. Not accomplished. Due to shifts in program priorities based on funding levels, this report was not a focus of State staff this year. However, moving forward we recognize that a summary of WIC’s contributions and accomplishments will be very important to justify and secure limited Federal funds. Overall, the report format and data tables are in process. Data for the program’s 5 process & outcome objectives has been analyzed and graphed; corresponding narrative sections are partially drafted. 1.4 Provide a 1-2 day leadership and management workshop for Local Agency Coordinators/Program Nutritionists/SA staff. Secure facilitator, date, content and location (retreat location). • By end of 2nd quarter, develop and finalize contract • Attend logistics meetings. • Conduct meeting. • Evaluate and plan for future/ongoing training. N/A Workshop offered. Evaluation drives improvements in program operations Due to the reduced budget, this meeting was not accomplished. However, provided updates at Program Coordinators’ meetings on Local agency plan and Developed framework for local agency technical assistanceSee Functional Area 2 for details. As funds become available, plan follow-up retreat. 1.5 Review, update and enhance WIC Continuity of Operations/Disaster Preparedness Plan. Review and incorporate CT DPH COOP plan N/A Updated Plan Not accomplished. Will move this objective to 2013. CT WIC State Plan FY2013 Incorporate Disaster Preparedness Data Recovery (DPH IT) Plan components Provide training to State and Local Agency staff 11 Program Functional Area 2: Nutrition Services and Breastfeeding Support & Promotion Goal 2: Improve the nutritional and overall health of WIC families in Connecticut and to increase the proportion of WIC-enrolled infants who are breastfed exclusively for at least 6 months. Objective: 2.1 At least 70% of pregnant women participating in the WIC Program for a minimum of 6 months gain appropriate weight. Objective: 2.2 The incidence of low birth weight (LBW) among infants whose mothers were on the WIC Program for at least six months during pregnancy does not exceed 6%. Objective: 2.3 The prevalence of anemia among children enrolled in the WIC Program for at least one year does not exceed 7.5%. Objective: 2.4 a. The prevalence rate of BMI > 85th percentile to < 95th percentile for children 2-5 years does not exceed 15%. b. The prevalence rate of BMI > 95th percentile for children 2-5 years of age does not exceed 25%. Objective: 2.5 At least 60% of infants enrolled in the WIC Program initiate breastfeeding. Objective: 2.6 At least 25% of infants enrolled in the WIC Program breastfeed for 6 months or more. Objective: 2.7 Increase percentage of blood work results obtained and recorded in SWIS for postpartum women (result of deficient PC 2010 data findings) Objective: 2.8 Conduct a workshop for local agencies on development of core nutrition education lesson plans by September 30, 2012. Objective 2.1 At least 70% of pregnant women participating in the WIC Program for a minimum of 6 months gain appropriate weight. Strategies/Activities Continue to monitor trends and assess local agency staff skills in identifying women at risk for poor weight gain during pregnancy, and the effectiveness of education efforts on: • Weight gain during pregnancy • Nutrition during pregnancy • Smoking, ETOH/drug dangers • Referrals Expert speaker on domestic violence to speak at Statewide meeting. Develop content sheet specific to weight gain during pregnancy. Continue to monitor remaining local agencies for implementation of revised IOM pregnancy weight gain guidelines (NRC#10) CT WIC State Plan FY2013 Baseline 2012 WIC Goal: ≥70% FFY 2007: 66.9% Range: 56.2% - 82.4% FFY 2008: 65.7% Range: 57.3% - 78.4% FFY 2009: 67.2% Range: 57.9% - 76.5% FFY 2010: 66.4% Range: 42.3% - 81.3% FFY 2011: 68.8% Range: 59.0% - 81.1% FFY 2012: 72.2%* Range: 48.9% - 85.4% (* 9-month average) Source: CT SWIS, Outcome Objective #1 – Weight Gain during Pregnancy; quarterly reports, by federal fiscal year Indicators SWIS quarterly and annual reports. Referral & counter-referral reports. Results of monitoring show local agencies are using effective educational methods and appropriate education materials. Change in trend data over time for low performing agencies. Progress Chart audits and observations during monitoring (4 agencies) indicate that approximately 85% of local agency staff adequately addressed weight gain during pregnancy during education of pregnant clients. In process. Potential speaker to meet with state staff in FY 2012 to discuss content. Guidance document planned to be completed by September 30. Identified specific educational materials and/or lesson plans may be limited, depending on funding or availability of revised Tips for Pregnancy/My Plate are available. The four (4) agencies monitored to date; Optimus, Hartford, East Hartford and New Haven have implemented the revised IOM pregnancy weight gain guidelines. Accomplished. All local agency plans were reviewed by state staff and feedback provided to the agencies. 12 Con’t 2.1 At least 70% of pregnant women participating in the WIC Program for a minimum of 6 months gain appropriate weight. Review action steps of all local agency plans on maternal weight gain. Developed framework for local agency technical assistance. Attached to State Plan submission. Each Nutrition Unit staff member without monitoring duties will be assigned to 3 local agencies as a Local Agency Liaison. These staff are responsible for following up on ME findings, CAP, LAP development and areas of low performance. Initial technical assistance visits to be completed by September 30, 2012. • FFY 2012 Target: ≥ 70% • Statewide average (based on 9-mos of FY data): 72.2% (R = 48.9% - 85.4%) • Identify lowest performers: objective met. - Waterbury/Naugatuck: 66.0% - Hartford: 67.3% - New Haven: 68.3% • Identify best performers: objective met. - Norwich/New London: 80.8% - Danbury: 77.6% - Torrington: 77.4% Provide technical assistance to the two (2) lowest performing local agencies identified for this objective. See Functional Area 12, Data Quality, Analysis and Reporting for information on these activities. 2.2 The incidence of low birth weight (LBW) among infants whose mothers were on the WIC Program for at least six months during pregnancy does not exceed 6%. Continue to monitor trends and improve weight gain during pregnancy. During observations monitor for nutritionist identification and discussion of contributing factors for this risk • History of LBW or pre-term delivery; • Mother’s age, etc. Review action steps of all local agency plans for LBW. Provide technical assistance to the two (2) lowest performing agencies for this objective. See Functional Area 12, Data Quality, Analysis and Reporting for information on these activities. CT WIC State Plan FY2013 2012 WIC Goal: ≤ 6% FFY 2007: 5.9% Range: 1.5% - 9.4% FFY 2008: 5.9% Range: 3.6% - 9.5% FFY 2009: 5.8% Range: 2.6% - 9.1% FFY 2010: 5.8% Range: 1.8% - 10.0% FFY 2011: 6.1% Range: 3.5% - 8.5% FFY 2012: 6.0%* Range: 2.1% - 8.7% (* 9-month average) Source: CT SWIS, Outcome Objective #2 – LBW Incidence; quarterly reports, by federal fiscal year. SWIS quarterly and annual reports Reduce health disparities. Results of monitoring show local agencies are using effective educational methods and appropriate education materials. Change in trend data over time for low performing agencies. During observations, 90% of Nutritionists identify and discuss the contributing factors for LBW with clients. Accomplished. All local agency plans were reviewed by state staff and feedback provided to the agencies. • FFY 2012 Target: ≤ 6.0% • Statewide average (based on 9-mos of FY data): 6.0% (R = 2.1% - 8.7%) • Identify lowest performers: objective met. - Windham/Putnam: 7.4% - New Haven: 7.1% - Norwich/New London: 6.7% • Identify best performers: objective met. - Danbury: 3.6% - Torrington: 3.7% - Meriden/Middletown: 4.0% 13 2.3 The prevalence of anemia among children enrolled in the WIC Program for at least one year does not exceed 7.5%. Monitor trends and assess local agency staff skills in identifying children at risk for anemia and effectiveness of education efforts on: • Iron-rich food sources, explanation of anemia/ risks, importance of timely blood work, appropriate iron supplementation and low-iron’s connection with risk for lead poisoning. • Making appropriate referrals and follow-up. Monitor for local agency incorporation of anemia content sheet messages into individual education sessions 2.4 a. The prevalence of BMI > 85%ile to < 95%ile for children 2-5 years of age does not exceed 15%. b. The prevalence of BMI > 95%ile for children 2-5 years of age does not exceed 25%. Work with IT staff to incorporate BMI as a new quarterly outcome objective for FFY 2012, and to generate the needed data by local agency, age group, race/ethnicity and town of residence. Monitor for local agency incorporation of content sheets targeted to prevent obesity- fruit and vegetable intake, physical activity and introduction to solids See Functional Area 12, Data Quality, Analysis and Reporting for information on IT and Epi specific activities related to this objective. 2012 WIC Goal: ≤ 7.5% FFY 2007: 8.1% Range: 2.7% - 12.5% FFY 2008: 7.9% Range: 3.4% - 10.4% FFY 2009: 7.6% Range: 3.9% - 10.5% FFY 2010: 6.8% Range: 2.4% - 10.6% FFY 2011: 6.8% Range: 4.1% - 8.8% FFY 2012: 7.7%* Range: 4.4% - 10.3% SWIS quarterly and annual reports Results of monitoring show local agencies are using effective educational methods and appropriate education materials Change in trend data over time for low performing agencies (* 9-month average) Source: CT SWIS, Outcome Objective #4 – Anemia Rate; quarterly reports, by federal fiscal year. WIC 2012 Goal: N/A CT WIC Program Data: BMI ≥ 85 & < 95%ile: FFY 2007: 9.7% Range: 9.2% - 10.2% FFY 2008: 9.5% Range: 9.1% - 9.8% FFY 2009: 9.7% Range: 9.5% - 10.0% FFY 2010: 9.3% Range: 9.0% - 9.5% FFY 2011: 9.8% Range: 9.4% - 10.1% FFY 2012: 9.8% * Range: 9.6% - 10.0% During observations, 90% Nutritionists are using effective education methods and appropriate educational materials. • FFY 2012 Target: ≤ 7.5% • Statewide average (based on 9-mos of FY data): 7.7% (R = 4.4% - 10.3%) • Identify lowest performers: objective met. - Hartford: 9.9% - Norwich/New London: 9.4% & Bridgeport: 9.4% - Bristol/New Britain: 8.4% & Meriden/Middletown: 8.4% • Identify best performers: objective met. - Danbury: 5.7% & New Haven: 5.7% - Torrington: 6.1% - Windham/Putnam: 6.2% SWIS quarterly and annual reports See Certification Section for information on updated Nutrition Risk criteria. Childhood BMI or obesity Outcome Objective is included in FY 2013 State Plan. Accomplished. SWIS quarterly report will be generated beginning October 1, 2012. Included revised overweight and obesity targets into Local Agency Plan performance standards and nutrition outcome objectives. (* 7-month average) BMI ≥ 95%ile: FFY 2011: 11.0% Range: 10.6% - 11.4% FFY 2012: 10.93% * Range: 10.8% - 11.0% (* 7-month average) CDC/PedNSS Data: BMI: 85<95 CY 1985: 11.0% ≥95 6.7% CT WIC State Plan FY2013 14 Con’t 2.4 a. The prevalence of BMI > 85%ile to < 95%ile for children 2-5 years of age does not exceed 15%. CY CY CY CY CY CY CY CY CY CY b. The prevalence of BMI > 95%ile for children 2-5 years of age does not exceed 25%. 2.5 At least 60% of infants enrolled in the WIC Program initiate breastfeeding. 1990: 1995: 2000: 2005: 2006: 2007: 2008: 2009: 2010: 2011: 14.5% 15.0% 17.9% 16.3% 16.5% 16.0% 15.7% 15.4% 14.9% 15.3% 11.0% 13.2% 16.6% 16.6% 16.2% 16.2% 15.5% 16.0% 15.8% 15.9% Source: CDC, Pediatric Nutrition Surveillance System. Connecticut (calendar year); Table 12C. Coordinate statewide WIC breastfeeding promotion and support activities. WIC BF Committee meeting and activities. - Meet quarterly in person and/or via conference call - Using LS Grow and Glow curriculum, develop consistent content for breastfeeding group education. -Revise, as needed Connecticut Breastfeeding Guidelines, provide training to local staff and incorporate updates into State Plan-Provide technical assistance to LAs in implementing WIC BF guidelines and annual BF promotion plans. - Conduct three (3) breastfeeding focused site reviews in FY 2012. (Schedule reviews by end of first quarter) -Continue to monitor implementation of four (4) breastfeeding content sheets. CT WIC State Plan FY2013 WIC 2012 Goal: ≥ 60% FFY 2006: 57.2% Range: 43.5% - 88.4% FFY 2007: 59.1% Range: 45.0% - 87.6% FFY 2008: 61.3% Range: 49.3% - 89.0% FFY 2009: 63.7% Range: 52.1% - 88.9% FFY 2010: 65.8% Range: 53.9% - 91.2% FFY 2011: 65.0% Range: 49.8% - 88.4% FFY 2012: 68.7%* Range: 48.5% - 91.4% (* 9-month average) Source: CT SWIS, Outcome Objective #3a – BF Initiation Rate; quarterly reports by federal fiscal year. Documentation of improved compliance with guidelines per technical assistance reviews and monitoring reports. More than half of agencies visited will meet or exceed performance standards. Record of meetings and joint tasks or activities accomplished from CBC, CT Chapter of the American Academy of Pediatrics (CT-AAP) and other groups. Completed 3 BF coordinator meetingsOctober, January and April. Last 2012 meeting scheduled for July. Agendas attached. Revised Food Package section of CT Breastfeeding Guidelines to focus on appropriate formula supplementation for mom who both BF and give formula. Reviewed tips to incorporated Breastfeeding: You Can Do it! DVD in group and individual education. Focus on FAQ section and facilitated discussion. Completed 7 BF technical assistance reviews- Waterbury and Bristol, New Haven WIC = St. Raphael’s, Yale New Haven, Hill Health Center sites, East Hartford and Hartford. Additional TA Visits planned for Fair Haven site on 7-18-12 Meriden on 7-20-12 and Torrington in August. Staff use of BF content sheets monitored during TA visits. Provided several sites with suggestions for staff self-directed learning and enrichment. Main areas for improvement in those local agencies reviewed are staff education and learning environment. • FFY 2012 Target: ≥ 60% • Statewide average (based on 9-mos of FY data): 68.7% (R = 48.5% - 91.4%) • Identify lowest performers: objective met. - Torrington: 53.2% 15 Con’t 2.5 At least 60% of infants enrolled in the WIC Program initiate breastfeeding. 2.6 At least 25% of infants enrolled in the WIC Program breastfeed for 6 months or more. Manage WIC Breastfeeding Peer Counseling Programs. • Monitor performance of Hartford and New Haven programs. Submit reports to USDA. • Continue to implement pilots and refine protocols. -Begin to analyze data for pilot sites. Follow-up on implementation of USDA’s Loving Support: Building Breastfeeding Competencies initiative. • Incorporate portions of the Grow & Glow modules into bi-annual State orientations. Follow-up on sustainability of Connecticut Breastfeeding Initiative with DPH partners. Provide support as needed to NAPO. Coordinate at least one (1) Breastfeeding-focused CTAAP teleconference in FY 2012. Actively participate in the CT Breastfeeding Coalition (CBC). With Epi and IT Units, review calculation of breastfeeding duration, and make any necessary adjustments. CT WIC State Plan FY2013 WIC 2012 Goal: N/A HP 2010 Goal: 25% WIC Program Data: FFY 2006: 7.0% Range: 0.2% - 22.7% FFY 2007: 7.8% Range: 0.5% - 18.9% FFY 2008: 8.0% Range: 2.9% - 16.0% FFY 2009: 9.4% Range: 2.8% - 15.7% FFY 2010: 7.0% Range: 1.1% - 17.2% FFY 2011: .% Range: .% - .% FFY 2012: .% Range: .% - .% Source: CT SWIS, Outcome Objective #3b - BF Duration; quarterly reports, by federal fiscal year. CDC/PedNSS Data: By Calendar Year: CY 1985: 7.2% CY 1990: 8.3% CY 1995: 11.3% CY 2000: 15.8% CY 2002: 23.8% CY 2004: 22.9% CY 2006: 24.6% CY 2008: 24.4% CY 2010: 27.0% By Race/Eth. & Year: Hispanic, by Year CY 2001: 24.6% CY 2003: 26.6% CY 2005: 26.1% CY 2007: 27.6% CY 2009: 29.9% CY 2010: 29.4% NH Black, by Year CDC’s Pediatric Nutrition Surveillance System (PedNSS) reports [Connecticut reports are derived entirely from CT’s Statewide WIC Information System – SWIS]. Record of meetings and technical assistance provided to local agencies, local agency BF coordinators and CT Breastfeeding Coalition Quarterly activity and expenditure reports from contractors, including # of women enrolled and duration rates. - Hartford: 53.4% - Bristol/New Britain: 63.1% • Identify best performers: objective met. - Danbury: 90.0% - Stamford/Norwalk: 78.5% - New Haven: 74.4% Performance of Hispanic Health Council (HHC) and Yale New Haven Hospital (YNHH) Breastfeeding Heritage and Pride (BHP) programs are tracked quarterly. Contract extension for YNHH program is at AG’s office. Revisions to WIC Clinic Peer Counseling Pilot forms and protocols are in process. Contract with consultant to organize and analyze available data from pilot sites. Peer Counselor training update held on 10-27-12 for 3 peers. Planned and facilitated monthly training conference calls for 3 pilot sites and peers. Breastfeeding portion of bi-annual WIC Program Orientation revised 2011. Additional revisions to include facilitated discussion to model technique to new staff to be incorporated by August 2012. Attached presentation. Reviewed and provided extensive comments on CBI evaluation report from Professional Data Analysts Inc., (PDA). Provided information on CBI project as requested by Centers for Disease, Control and Prevention (CDC) to assist in the development of the BestFed beginnings project by NICHQ. Plan to submit manuscript on CBI to American Journal of Public Health for publication. CT-AAP/DPH joint teleconference scheduled for 4-24-12 Pediatricians’ Role in the BFHI. Secured speaker and consulted on announcement and learning objectives. Will assist physicians in CT in getting 1 hour of required education as for BFHI designation. Board member of CBC. Attend quarterly meetings. Legislation for postponement of 16 Con’t 2.6 At least 25% of infants enrolled in the WIC Program breastfeed for 6 months or more. 2.7 Increase percentage of bloodwork results obtained and recorded in SWIS for postpartum women (result of deficient PC 2010 data findings). 2.8 Conduct workshop for local agencies on development of core nutrition education lesson plans by September 30, 2012. See Functional Area 12, Data Quality, Analysis and Reporting for information on IT and Epi specific activities related to this objective. CY CY CY CY CY CY 2001: 2003: 2005: 2007: 2009: 2010: 23.1% 20.5% 17.8% 21.7% 23.6% 25.5% CY CY CY CY CY CY 2001: 2003: 2005: 2007: 2009: 2010: 20.2% 18.1% 21.7% 19.5% 23.1% 23.1% Jury duty for breastfeeding mothers passed. Link to law: Contributed to development of DPH Nursing Mothers’ Policy, employee orientation packet and supervisory training materials. Joint venture with AAO and HR. NH White, by Year Source: CDC, Pediatric Nutrition Surveillance System. Connecticut, 2010 (calendar year); Table 13C. Continue to identify local agency with issues obtaining current bloodwork for postpartum participants. Develop solutions to improve access for postpartum women to obtain bloodwork. Monitor 10 additional postpartum files targeting bloodwork data. Using nutrition education guidance content sheets developed in 2011, plan and present Statewide workshop for local agency nutrition staff on development of core nutrition education lesson plans. After workshop, state staff will review draft lesson plans from each workgroup and finalize for statewide use. Concurrently, local agencies will determine which of the 5 core lesson plans they will use and how they will implement in their agencies by Sept. 30, 2012. PC error reports data? PC 2012 Data, CDC’s Pediatric Nutrition Surveillance System (PedNSS) reports Chart audit results In the four (4) agencies monitored, blood work was documented in 97% of the post-partum charts audited. FY 2011 nutrition education guidance content sheets • Anemia • Smoking and pregnancy • Introduction to solids • Vegetable and fruit consumption • Physical activity Local agency plans and objectives. Five (5) core lesson plans are developed and finalized. Local agencies implement at least one (1) core lesson plan in nutrition services provision in FY 2012. Accomplished. Workshop provided to all nutritionists on March 9, 2012 and draft nutrition education lesson plans developed. In process, plans for final drafts by June 30, 2012. Partially accomplished. A mandatory nutrition objective specific to nutrition education lesson plans was added for fiscal year 2012 for all local agencies. A follow up status report will be requested of all agencies to be submitted to the State WIC Office before the end of the fiscal year as part of their local agency plan progress report. 17 CT WIC State Plan FY2013 Program Functional Area 3: FOOD DELIVERY AND FOOD INSTRUMENT ACCOUNTABILITY Goal 3: To improve food delivery operations at the state and local agency level. Objective: Objective: Objective: Objective: 3.1 3.2 3.3 3.4 Increase to 90% timely local agency submission of unused check stock inventory reports. Decrease the number of rejected checks for selected rejection reasons by 10%. Make changes to food packages and eligible foods in response to Final Rule for Revisions in the WIC Food Packages. Improve access to special formulas at retail stores. Objective 3.1 Increase to 90% timely local agency submission of unused check stock inventory reports. Strategies/Activities An e-mail reminder will be sent to the LAs if the report is not received by the middle of the month. A telephone call reminder will be made to Las if the report is not received by the last week of the month. Non-compliant local agencies will continue to be cited and monitored for future compliance during management evaluations. Baseline Currently an average of 87% compliance Indicators Compliance of local agency reports. Decreased finding of non-compliance in management evaluation reports. N/A Monitoring report findings. Results of the unused check stock inventory report spreadsheet. 3.2 Decrease the number of rejected checks for selected rejection reasons by 10%. Provide written policy to LAs on handling voided in-hand checks and the immediate detection of misnumbered checks that lead to rejections. Follow up on agencies based on reports. 586 rejected checks due to distribution of checks that were voided-in-hand or misnumbered Reduction in the number of checks rejected due to misnumbering and checks voided-in-hand, but distributed to participants. Try to amend the Banking Services contract to allow vendors to place the vendor stamp in the endorsement area of the back of the WIC check as well as the required placement on the front of the check. 5384 rejected checks due to illegible vendor stamp Reduction in the number of checks rejected due to the bank’s inability to read the stamped vendor numbers. Store implementation of new endorsement rule. Progress The average % compliance for the first 5 months of the FY is 89%. The average % compliance for the last 3 completed months of the FY is 92%. Accomplished. During FFY2012 all local agencies were in compliance with this mandate. A numbered memo to provide written policy to LAs will be completed and distributed during Q3 2012. Vendor bulletin was sent in November 2011 as to how stores can prevent rejected checks. Request was made in Q1 for Office of the Treasurer to reword banking contract to include this language, but as of 7/25/12, the RFP has not been released. 18 CT WIC State Plan FY2013 3.3 Make changes to food packages and eligible foods in response to Final Rule for Revisions in the WIC Food Packages. Changes to food list, minimum inventory, pricing and monitoring reports will be needed. Review the influx of submissions from manufacturers and distributors on product nutrition labels, statewide availability and retail costs Revise the CT WIC approved food list, the maximum monthly quantities in food packages and forms to be used in food delivery at the local agency (e.g. medical documentation). Secure and adapt education materials. If needed, finalize the vendor and farmer agreements to update the minimum inventory requirements and the procedures for processing the fruit & vegetable check. If needed, provide bulletin for training on new regulations or procedures Final rule expected in December 2011. Emails and information submitted to the State WIC Office for approval in Connecticut. As of 7/25/12, Final rule has not been released, so any necessary changes are unknown and project is delayed. 2nd Quarter of FY12 New Food List is printed. As of 7/25/12, Final rule has not been released, so any necessary changes are unknown and project is delayed. 2nd Quarter of FY12 New Agreements are printed and executed. As of 7/25/12, Final rule has not been released, so any necessary changes are unknown and project is delayed. 2nd Quarter of FY12 Bulletins sent to all WIC authorized vendors and farmers. As of 7/25/12, Final rule has not been released, so any necessary changes are unknown and project is delayed. If needed, communicate necessary SWIS changes in food packages to IT 2nd Quarter of FY12 Changes have been tested. As of 7/25/12, Final rule has not been released, so any necessary changes are unknown and project is delayed. If needed, provide updates to local agencies regarding any new policies, educational materials, and changes to the usage of the fruit & vegetable check. If needed, notify wholesale distributors of updates to food packages, new food items, and minimum inventory requirements. Issuance of all CT WIC checks reflecting full implementation of the new food package changes for all categories of WIC participants. 2nd Quarter of FY12 Numbered memo sent. As of 7/25/12, Final rule has not been released, so any necessary changes are unknown and project is delayed. 2nd Quarter of FY12 Mailing list. 2nd Quarter of FY12 Issued check files. As of 7/25/12, Final rule has not been released, so any necessary changes are unknown and project is delayed. As of 7/25/12, Final rule has not been released, so any necessary changes are unknown and project is delayed. CT WIC State Plan FY2013 New peer group maximums are sent to the bank. 19 3.4 Improve access to special formulas at retail stores. Develop a document utilizing our spreadsheet of all CT WIC-approved formulas and medical foods for participant/local agencies to order formula at authorized WIC vendor locations. 1st Quarter of FY12 Facilitate WIC participants’ obtaining products that are printed on their WIC checks in a timely manner. Distribute document to local agencies for participant use, as well as authorized vendors and their corporate offices. Include the document in printed annual training materials and interactive training presentations. 1st Quarter of FY12 Vendors are able to better serve WIC customers needing formulas and medical foods. Make vendors aware that the tool exists to help serve WIC customers’ needs. 2nd – 4th Quarters of FY12 Document needs major revisions due to recent changes in formula names and package sizes. Ordering codes are needed from formula distributors. Postponed to 2013. Postponed to 2013. Postponed to 2013. 20 CT WIC State Plan FY2013 Program Functional Area 4: Vendor Management Goal 4: To improve communication and effectiveness in Vendor Management. Objective: Objective: Objective: Objective: Objective: 4.1 4.2 4.3 4.4 4.5 Enhance the WIC website and email usage to provide important vendor-related information. Implement a pilot for open enrollment of stores to become WIC authorized vendors. Increase from 10% to 50% the number of compliance investigations that are initiated and completed within FY 2012. Utilize a Microsoft Access database to improve the tracking of application/authorization processes. Investigate and determine the process for changing State Regulations. Objective 4.1 Enhance the WIC website and email usage to provide important vendorrelated information. Strategies/Activities Maintain links to federal regulations, vendor authorization process, vendor agreement and a monthly list of currently authorized vendors and farmers’ markets. Baseline 2011 information Indicators Changes are needed for updated information. Progress Link to federal regulations has been maintained, WIC Vendor Agreement and updated food list was posted in Q1. Website utilized for open enrollment in Q2 and email system utilized for responses to open enrollment make up training. Website wording updated and the authorized vendor list is posted monthly. Pending: update map of Local Agency sites on website, following conclusion of RFP process & award of new contracts. Add & maintain map locating currently authorized vendors. Include our email address on all correspondence to vendors to encourage submission of information and questions to the program. 10% of vendors in FY11 An increase in the number of emails received from vendors. Email system being utilized for notification of open enrollment opportunity, price updates from WIC vendors, requests for additional food lists and authorized vendor list. Monitor vendors’ usage of email as a first point of contact and notify vendors of the need for each vendor ownership, to have an email address by October 1, 2012. Currently only prospective vendors are using email to respond to needs assessment postings because it’s required. Increased utilization of the website by vendors to obtain relevant information. Reduction in calls for information that is provided on the website. Majority of vendors are still calling WIC staff with questions, however food lists and the list of authorized vendors has been requested electronically. Communication on WIC requiring an email address is planned for August of Q4. CT WIC State Plan FY2013 21 Con’t 4.1 Enhance the WIC website and email usage to provide important vendorrelated information. 4.2 Implement a pilot for open enrollment of stores to become WIC authorized vendors. Utilize distribution list of vendors’ email addresses to improve communications and encourage website usage. Only used email for communications from the State WIC Office to farmers in FY10. Increased communications to vendors via email. Evaluate effectiveness of the website content and revise according to the needs of both the state and vendors, if deemed appropriate for publication. Website’s potential is only partially realized. Updates to website information based on vendor feedback/questions. Reduction in calls received for routine information. Increased number of state staff referrals to the website for information. In January 2012, post on the website, the statewide opportunity for stores to apply to become authorized to accept WIC checks. Periodic needs assessments and postings for specific locations have been used for the last 5 years. Limiting the number of authorized vendors has caused a sense of unfairness in the vendor community, staff time has been consumed with questions, and we have not been able to authorize large independently owned supermarkets. Utilized distribution list of past potential applicants to inform vendors of open enrollment opportunity posted on website. Continued usage of email notifications to WIC Vendor Advisory Council members regarding vendor bulletins and Price Stock Survey (PSS) due dates. Notification of August PSS due date and bulletins will be sent via email using distribution list of authorized vendors in Q4. Referrals to the WIC Vendor Agreement on website made in response to callers’ questions. Accomplished. Posting was made, 230 stores registered for training through Survey Monkey indicating that they are interested in applying for WIC authorization and posting removed on January 31st. 22 CT WIC State Plan FY2013 Con’t 4.2 Implement a pilot for open enrollment of stores to become WIC authorized vendors. 4.3 Increase from 10% to 50% the number of compliance investigations that are initiated and completed within FY 12. In February 2012, training will be conducted and applications will be reviewed. 2nd quarter of FY12 Review responses to posting and supply applications to stores that are eligible to apply. In February and March, 12 training sessions total were held in Bridgeport, Waterbury, East Hartford, Norwich, Windsor and Hamden in English and Spanish. 185 stores attended and were trained while WIC staff reviewed all applications on site. 9 stores were not trained because they did not have an application package, 58 application packages were incomplete and returned to the stores, 127 application packages were complete and accepted. In March and early April 2012, monitoring visits will be conducted and determinations made for the stores that will be authorized. Late 2nd and 3rd quarter of FY12 The submission of a complete application package and the passing of an onsite monitoring visit. In late April and May, non-select stores who do not meet all selection criteria and provide stamp and an executed agreement to stores that may be authorized. 3rd quarter of FY12 Check stores against all selection criteria (application requirements met, minimum inventory met, etc.) During the first quarter, select stores to be investigated, have contractor perform initial compliance buys and DPH to review compliance buy reports. 10% As of October 1, 2011, 5% of the authorized vendors are investigated early in the fiscal year. Monitoring visits were conducted, stamps were ordered and authorizations occurred for stores that met all selection criteria. As of 7/25/12, over 100 stores were authorized. Process was expected to be completed by May 1st, but has been delayed to May 30th. No action is being taken on 5 stores due to not submitting an application and 58 stores have received non selection letters. From the FY11 TIP report, 53 ongoing investigations have been identified that must be closed this year. Most new investigations will be initiated in FY13. During the second quarter, send sanction letters and confirm receipt of notice of violations if applicable. N/A Results of the compliance buy that identifies if violations occurred which may necessitate a sanction letter. Sanction letters were sent for violations identified during compliance buys done in FY11. 23 CT WIC State Plan FY2013 Con’t 4.3 Increase from 10% to 50% the number of compliance investigations that are initiated and completed within FY 12. 4.4 Utilize a Microsoft Access database to improve the tracking of application/ authorization processes. During the third quarter, have contractor perform follow up compliance buys as needed. N/A Additional compliance buys performed on vendors that would have received warnings. Compliance buys are being planned for July for ongoing investigations, as well as initial buys for newly opened investigations on additional stores. During the fourth quarter, send additional sanction letters if applicable. N/A At least 50% of investigations are deemed to be complete. It is expected that by August, half of the ongoing investigations will be closed with the rest being closed by the end of the 4th quarter. Follow up buys will be performed in Q4 and sanction letters will be sent after closing the investigations, along with new buys that will carry over into FY13. Develop forms that feed data into the Vendor Management database. Database is developed and currently in use as a table only. Standardized queries and reports developed to meet VM staff needs. In January 2012, forms were developed that link to the All Vendors database to feed the Vendor Management database to track application status, monitoring visits and stamp requisitions. Obtain pertinent training for all vendor management staff Minimal knowledge of and experience with MS Access software “How-To” fact sheets and other resources developed and shared with Vendor Management staff. Expansion of staff knowledge base. In Q1, the office assistant took Access training and set up the database with forms for data entry. In Q2, monitoring staff were trained in how to use them and additional staff is being encouraged to attend Access training currently being offered. Query the database for vendors included in each aspect of the application process (e.g. renewals, new stores under the same ownership, stores in the enrollment process, etc.). Vendor application information is in an Excel documents. Vendor database tracks and reports out vendor management activities by phase, and increases the efficiency and accuracy of the vendor application, selection and authorization process, from a store’s initial request, through training, and determination of authorization. The database was used in Q2 for tracking open enrollment and multiple stores under the same ownership applications. Beginning in June, it was utilized to track monitoring visits for the renewal process of vendors whose agreements are expiring at the end of FY12. CT WIC State Plan FY2013 24 Con’t 4.4 Utilize a Microsoft Access database to improve the tracking of application/ authorization processes. 4.5 Investigate and determine the process for changing State Regulations. Utilize queries to track progress and determine if internal deadlines will be met or need to be adjusted. Currently tracked through multiple Excel spreadsheets. Increased efficiency in managing yearly application/authorization tasks. Will be done in Q4 to assess if all stores who meet the selection criteria get authorized and non select those stores who do not meet the criteria. Utilize database to facilitate updating information and preparing the annual TIP report (The Integrity Profile). Currently tracked through the Access table and Excel spreadsheets. Decrease in time to complete the TIP report. Being used to determine newly authorized stores since October 1, 2011 and information being entered into the FY12 TIP report. Review Federal Regulations and current State regulations to identify areas that are inconsistent Current state regulations have been in effect since June 1998. Vendor Management policies are compliant with federal regulations, but have changed since state regulations were last updated. Not accomplished. Planned for FY 2013. Identify and document the expedited process for changing certain regulations and determine when it is (for what changes) appropriate to use this process. Explore the regular process for changing regulations and determine which required changes can be completed using this process. Not accomplished. Planned for FY 2013. Not accomplished. Planned for FY 2013. 25 CT WIC State Plan FY2013 Program Functional Area 5: Management Information Systems Goal 5: To maintain and enhance the WIC IT infrastructure. Objective: Objective: Objective: Objective: Objective: Objective: Objective: Objective: Objective Objective: 5.1 Implement solutions or new technologies to address changes in USDA regulations and/or state policy. 5.2 Establish a structured approach to Release Management and Helpdesk Support 5.3 Establish a master schedule for all WIC IT projects 5.4 Continue the mainframe cost containment initiative. 5.5 Procure an MIS and EBT solution for Connecticut. 5.6 Move towards a self service reporting environment for regular WIC information needs 5.7 Prepare for data migration and conversion to new MIS 5.8 Repair or replace broken or outdated equipment as part of IT life cycle plan. 5.9 Increase staff knowledge and utilization of current IT languages, tools and techniques 5.10 Implement new technologies to enhance productivity or system security. Objective 5.1 Implement solutions or new technologies to address changes in USDA regulations and/or state policy. Strategies/Activities Re-program SWIS as required to accommodate changes in regulations and/or policy. Deploy new technologies as required by changes in USDA and/or DoIT policies. Baseline NewSWIS version 1.61 Indicators Progress SWIS has been updated to support new growth charts. Additional updates have been made to ensure system is always backed up locally and at the state offices in the event of a failure. 5.2 Establish a structured approach to Release Management and Helpdesk Support. Establish a formal process for enhancements and helpdesk support. Enable web access to self service helpdesk system. No current consistency Process created and followed Increased use of TrackIt Reduced administration time for helpdesk staff. Process has been created. An email connection to TrackIt has been implemented rather than require users to learn this system. 5.3 Establish a master schedule of all WIC IT projects. Create and maintain a master schedule of IT activities. All projects independent Master calendar created and maintained. Staffing and budget cuts have deferred this initiative. 5.4 Continue the mainframe cost containment initiative. Monitor various processes for usage, printing, disk and tape storage costs. Move certain processes from mainframe to server. Remove obsolete report processes. Mainframe costs from prior year for given month Maintain MF cost in report of MIS Cost Survey Feb 2010. Mainframe costs stayed static for this year. CT WIC State Plan FY2013 26 5.5 Procure an MIS and EBT solution for Connecticut. 5.6 Move towards a self service reporting environment for regular WIC information needs. 5.7 Prepare for data migration and conversion to new MIS. 5.8 Repair or replace broken or outdated equipment as part of IT life cycle plan. 5.9 Increase staff knowledge and utilization of current Programming languages, tools and techniques. Complete BEST required documents for system selection. Complete IAPD. Issue RFP. Award RFP. Identify standard reports for automatic creation. Look at intranet or report server options for distribution. Look at adhoc reporting capabilities for common requests. Updating SWIS technical documentation. Create data dictionary. Purging old data. Data scrubbing. Manual cleanup by Las. Conversion strategy for phased rollout. Maintain operational status of IT infrastructure by providing timely service or replacement of defective equipment. Maintain inventory of IT equipment and implement. Replacement plans as dictated by resources and budget. Create upgrade/refresh schedule for next 18 months. Include professional development as part of annual review criteria. Lunch and learn sessions to share knowledge. WIKI or sharepoint sites for all system. Feasibility Study and related documents BEST Approval. USDA Approval. RFPs Issued. RFPS Awarded. Budget cuts have delayed project. Feasibility Studies and IAPD have been completed. Currently awaiting USDA approval. As defined by CDC, USDA, program requirements and epidemiologist work Standard report list with creation calendar. Pilot intranet or report server. Pilot Adhoc reporting capability. Initiative was put on hold because of budget cuts. System documentation. Data dictionary. Old data purged. Data scrubbed. Conversion strategy document. Documentation has been started, but not completed because of budget cuts. Current IT infrastructure LAs are able to provide adequate services to participants during equipment downtime. End of Life determined for all key IT assets. Publically available upgrade/refresh schedule for next 18 months. Obsolescence plan created, but funding is not available to implement. Older high use servers are being swapped out with newer machines where possible, but otherwise machines are only being replaced at failure. Current knowledge and tools Increased professional development. Lunch and learn sessions. Build out of WIKI or SharePoint sites for all systems. Planned but not implemented based on staffing reductions. 27 CT WIC State Plan FY2013 5.10 Implement new technologies to enhance productivity or system security. Deploy new technologies to enhance productivity or system security. Larger or dual monitors. Intranet or Sharepoint for organizing information. Implement LINC (MS Communicator) for interagency communication. New switches for remote site admin. Current IT infrastructure New switches purchased. Installations expected to be completed by July 1. Larger monitors are replacing smaller monitors when they fail based on budget issues. Intranet, Sharepoint and LINC deferred based on budget cuts. 28 CT WIC State Plan FY2013 Program Functional Area 6: Caseload Management/Outreach Goal 6: Effectively reach all eligible individuals as resources allow, and achieve the maximum caseload capacity to serve the greatest number of women, infants and children. Objective 6.1: Objective 6.2: By September 30, 2012, increase by 2% enrollment of high-risk applicants by evaluating local agency targeted outreach activities for these populations. By September 30, 2012, decrease the no-show rate by 5% using baseline established by each local agency as reference point. Objective 6.1 By September 30, 2012, increase by 2% enrollment of highrisk applicants by evaluating local agency targeted outreach activities for these populations. Strategies/Activities 1st trimester enrollment of pregnant women is greater or equal to 50%. Determine feasibility of tracking early enrollment of infants within first six weeks of life. If feasible, develop report to provide data to local agencies for program evaluation and planning. Review all local agency plans for evaluation of outcomes of prior year’s outreach activities and changes that were incorporated for future outreach activities based on reported results. During monitoring and for those agencies that are conducting the selfassessments, review current outreach strategies with local staff to ensure outreach plan remains relevant. Provide on-site technical assistance as needed. CT WIC State Plan FY2013 Baseline 2012 WIC Goal: ≥ 50% FY 2006: 49.5% Range: 16.4-74.9% FY 2007: 47.9% Range: 19.4-62.2% FY 2008: 48.2% Range: 25.6-57.6% FY 2009: 50.3% Range: 26.2-66.3% FY 2010: 50.9% Range: 30.7% - 67.4% FY 2011: 53.6% Range: 40.8% - 66.2% FFY 2012: 53.5%* Range: 39.9% - 71.5% (* 9-month average) Source: CT SWIS, Process Objective 1 – 1st Trimester Entry into WIC, quarterly report Indicators SWIS Process Objective Report (FY 2012 Range should be 39.3%-71.5%) Baseline or indicator to be established. Data points of infant’s birth date and certification date can be use to generate report. Quantitative assessment of each Outreach Activity carried out reported in local agency plan. Progress 1st trimester enrollment remained stable. Continue to strive to increase enrollment for pregnant women. • FFY 2012 Target: ≥ 50% • Statewide average (based on 9mos of FY data): 53.5% (R = 39.9% - 71.5%) • Identify lowest performers: objective met. - Danbury: 41.7% - Windham/Putnam: 46.4% - E Hartford: 48.2% • Identify best performers: objective met. - Stamford/Norwalk: 63.6% - Meriden/Middletown: 59.3% - Hartford: 57.0% Accomplished. All local agency plans were reviewed by state staff and feedback provided to the agencies. Partially Accomplished: Development of Local Agency Quantitative Assessment method is in progress by each local agency. Recommendations made by Local Program Operations Monitors in order to evaluate effectiveness of Outreach activities. 29 6.2 By September 30, 2012, decrease the no-show rate by 5% using established local agency baseline. Ensure continued effective implementation of daily appointment reminder calls. Develop an automated, standardized report for tracking no-show rate. Identify lowest performing local agency and provide targeted technical assistance to improve outcomes. E.g. sharing of successful strategies from other agencies. TBD Verification that all local agencies are rate tracking, analyzing and implementing and effective strategies to reduce no-show rate. Verified in FFY2012 Local Agency Plans and during Administrative Monitoring Reviews during FFY2011. Partially Accomplished: Local agencies have developed a system to track the no-show rate, established a baseline and have identified this area as one in need of improvement in their FFY2012 Local Agency Plan. An automated report for tracking no-show rates was not developed. In FY 2013, a state standardized method for tracking no-show rate will be provided to local agencies based on the best methods developed by locals. 30 CT WIC State Plan FY2013 Program Functional Area 7: Coordination of Services Goal 7: Strengthen coordination of information and resources with other Connecticut State Agencies to respond to the needs of the WIC clients. Objective: 7.1 Maintain active coordination with at least 75% of identified key partners Objective: 7.2 In 90% of reviewed charts/clinic observations during monitoring visits appropriate mandated and targeted referrals were made. Objective 7.1 Maintain coordination with at least 75% of identified key partners. Strategies/Activities Continue to actively participate in State level MCH Task Forces, Head Start, Oral Health, Lead Prevention/Immunization programs, HUSKY (Medicaid Managed Care) and DSS. Continue to coordinate with DPH Food Protection Program, Consumer Protection Agency, and DPH Environmental Epidemiology. Connecticut was awarded a FY 2011 USDA WIC Special Project Concept Paper Development Grant to develop a full-grant proposal for the Connecticut WIC and Head Baseline Letters of agreement or MOU’s with Medicaid Managed Care (HUSKY), Immunization, SNAP-Ed, Child Enforcement Agency and TANF. Indicators Improvement of service delivery to mutual clients Policy and procedures on formula safety and recall Final WIC SPG Full grant is submitted and funded. Grant proposal is included in the State Plan submission. Continue SNAP Ed/WIC Program LYF/FYF Collaborative Initiative: • Coordinate with SNAP Ed as needed with local agency workshop/display plans • Incorporate routine use of SNAP Ed recipes in WIC education/resources used • Incorporate USDA core messages in WIC nutrition education where indicated. MOA with UCONN for full grant development Start Cross-Program Collaboration Project. CT WIC State Plan FY2013 Ensure safety of food/formula provided to WIC participants. Current recommendations/guidelines relevant to WIC participants are sent to local WIC agencies. Successful SNAP Ed workshops/displays at local agencies based on evaluations and feedback from SNAP Ed/local agencies/students SNAP-Ed Recipes utilized at local WIC agencies FNS Core Messages incorporated into WIC Nutrition Education lesson plans and/or other education materials Progress Ongoing. Oral Health staff will be conducting survey of WIC staff at the September 2012 Statewide meeting to assess the oral health knowledge base and practices of WIC staff. Accomplished and Ongoing. Coordinated with DPH environmental Epidemiology regarding sushi consumption inquiry in pregnant and breastfeeding women resulting in guidance added to DPH fish advisory information. Ongoing communication regarding new BPA law and data/research/impact on WIC. Coordination of current investigation by FPP, DCP, and FDA of WIC participant formula quality complaints on Nutramigen liquid conc and two other formulas. Several updates to local agencies regarding various food and formula recalls, items in the news etc. Per USDA Memo on 2012 WIC Special Projects Grant concept paper awardees: multi-purpose funds are not available due to their use to support caseload. No RFP was released. Full grant proposal has been drafted and will be submitted in 2013 if funds are available. Other options for smaller pilot are being explored in addition to sustaining and 31 Objective Con’t 7.1 Maintain coordination with at least 75% of identified key partners. Strategies/Activities Identify other State partners serving similar populations to improve coordination of services. 7.2 In 90% of reviewed charts/observations during monitoring visits appropriate mandated and targeted referrals were made. During reviews, assess local agency utilization of revised referral codes and referral policy and procedures. • Update revised policies/procedures if indicated. • Provide review of updated policies and procedures at Statewide Meetings as needed. Last year’s 7.3 not accomplished. Deferred until roll-out of new IS. See 7.2 FY 2011 Progress for details. Monitoring staff to continue to track during site reviews. More emphasis placed on referral and outreach goals and outcomes in local agency planning process. CT WIC State Plan FY2013 Baseline N/A Indicators Improved local level coordination with staff regarding referrals. All local agencies will utilize a Local Community Resource Guide on a regular basis. Improved documentation on provision of referrals and follow up. Improved consistency of use of referral codes by LA’s. LA’s develop internal process for tracking referrals (providing and following up). Reduction in review findings related to referrals. Progress strengthening collaboration with State level Head Start office. In process. SNAP Ed Loving Your Family Feeding Their Future group classes/displays collaboration continues on a limited basis due to funding. FY 2011 results and 2012 planned were shared at the December 2012 Statewide meeting. Displays had better return for investment than classes so more displays will be done this time around Accomplished. SNAP Ed recipes, with the My Plate logo, were requested and provided to all local WIC agencies. Spanish recipes developed by SNAP Ed and reviewed by WIC local agency translation team., and supplies distributed to local agencies. In process/ongoing. Core messages included in SNAP Ed recipes/SNAP Ed workshops/displays. Plan to incorporate messages/concept into guidelines/materials as appropriate. The 90% targeted goal for referrals was not reached in the four (4) agencies monitored to date. Documentation of referrals in SWIS, utilizing the referral codes continues to be an issue. Documentation of targeted referrals ranged from 10% to 30% in the four (4) agencies monitored. Follow-up to referrals were not documented in any of the agencies. 32 Program Functional Area 8: Civil Rights Goal 8: Establish and administer policies and procedures that ensure client-oriented customer friendly service environment for all applicants and participants and comply with Racial/Ethnic Federal mandate to ensure uniformity and comparability in the collection and use of data as required by OMB standards. Objective: 8.1 Objective: 8.2 Verify 100% of local agencies are in compliance with use of non-discrimination statement requirements and OMB racial/ethnic data collection standards. Conduct annual civil rights training for local agency staff Objective 8.1 Verify 100% of local agencies are in compliance with use of non-discrimination statement requirements and OMB racial/ethnic data collection standards. 8.2 Conduct annual civil rights training for local agency staff. Strategies/Activities Request copies of LA developed brochures, handbooks, and/or other publications and review for proper usage of the non-discrimination statement. Monitor to verify that Racial/Ethnic Data Collection procedures followed at local agencies during FY 2012 reviews. Update and train all State and local staff on revised discrimination complaint procedures. Explore a web-based, interactive module for annual civil rights training. • Review existing options • Recommendations to management by second quarter • Implement new training model in third or forth quarter of 2012. Baseline Ongoing Indicators Each brochure and handout will contain the non-discrimination statement. Progress Accomplished. During FY2011 95% of all local agencies have been in compliance with this mandate. Regulatory compliance as evidenced in monitoring reports. Web-based or some type of interactive training is implemented at local agencies. Accomplished. During FFY2011, State Program Operations Monitor researched and developed a Civil Rights Power Point Presentation, revised for updates by DPH - EEO Manager – Training was conducted during Statewide Meeting in September 2011 to all local and State agency staff. State Program Operations Monitor researched and developed language for Discrimination Complaint Procedures/Discrimination Complaint Form and Fair Hearing Procedures included in State Plan and revised for updates by DPH-EEO Manager. 33 CT WIC State Plan FY2013 Program Functional Area 9: Certification & Eligibility Goal 9: Improve and maintain program integrity in the areas of certification and eligibility. Objective: 9.1 90% of special formula procedures observed in reviews were accurate and complete. Objective: 9.2 Monitor local agency implementation of WPM Nutrition Risk Criteria Revision 10 (See Objective: 2.1) Objective: 9.3 Implement updated risk criteria by October 1, 2012 Objective 9.1 90% of special formula procedures during monitoring were accurate and complete. Strategies/Activities Continue to evaluate local compliance with special formula procedures during nutrition services monitoring • Review special formula log during reviews for accuracy and to determine frequency of insufficient “medical rationale” • Work with support units to obtain list of participants receiving special formulas and verify proper procedures were followed. Ten (10) participants at a minimum. • Based monitoring results, determine areas of improvement in the training of staff, and clarify WIC formula policies and procedures as needed. Continue to update formula resource tables, issue timely WIC numbered memos, provide in-service training and develop user-friendly formula resources for Nutritionists. Employ multi-level approach to improve local staff and medical community knowledge in area of formula issuance. CT WIC State Plan FY2013 Baseline June 2012 report: Exempt infant formulas Range-7.72-17.52% Average- 10.31% Updated information will be provided midOct. Indicators Local agencies will demonstrate proficiency with: • Following formula policies and procedures • Appropriate rational for ordering a special formula. Local agency report of improved knowledge base and comfort-level in interactions with HCP’s. Reduction in the number of health care provider phone calls related to confusion re: WIC special formula issuance SWIS Infant Formula Monthly Reports Progress The review of special formula logs during local agency monitoring indicates that formula procedures are being followed. Ongoing. Developed guidance and transmitted multiple numbered memos and email communications and technical assistance for local agency staff on formula related topics and formulary changes. State Plan Policy and Procedure Manual Food Delivery section (400) revised. Ongoing. Considering development of a WIC Nutrition Advisory committee which would include key stakeholders i.e. physician, clinical dietitians, pediatricians, public health nursing to discuss WIC nutrition policies and solicit feedback on current WIC nutrition issues to enhance consistent messages to participants and understanding of WIC policies and stakeholder needs. Provided training on WIC Program in general and addressed WIC formula policies for 10 Connecticut Breastfeeding Initiative (CBI) hospitals during one CBI networking conference call. Provided same training during January CBC meeting to educate staff from maternity care facilities on WIC breastfeeding support and clarify formula issuance policies. 34 Objective Con’t 9.1 90% of special formula procedures during monitoring were accurate and complete. 9.2 Monitor local agency implementation of WPM Nutrition Risk Criteria Revision 10. 9.3 Implement updated Nutrition Risk Criteria by October 1, 2012. Strategies/Activities • Respond to/solicit feedback from WIC medical advisor, key stakeholders Develop and provide two (2) in-service trainings to identified maternity care facilities regarding WIC formula policies and procedures by September 30, 2012. During FY 2012 chart audits target IOM weight gain grids and assignment of associated risks (USDA Risks 101, 111,131, 133 and 335) for accuracy. During observations local agency staff accurately incorporates revisions to USDA risks 411, 425 and 427 in risk assessment and counseling. Nutrition staff provide timely technical assistance or clarification when deficiencies are identified. By end of first quarter, review updated criteria, develop training plan and submit IT request to perform needed modifications to SWIS. Determine timeframe for system upgrades. Plan to train appropriate WIC staff on updated risks at March Statewide meeting. Develop mechanism to get feedback from locals on implementation of revised/new risk criteria (WHO growth charts). Provide tools for local agencies to educate key providers on WHO CT WIC State Plan FY2013 Baseline Indicators Progress Program Monitoring SWIS Nutrition Risk report Clinic observations, chart audits, Management evaluation results SWIS Report Chart Audits conducted during monitoring has identified plotting of the weight gain grid at certification and more so at follow-up visit was not done in approximately 50% of the pregnant woman’s charts in one local agency. During observations, about 85% of local staff accurately incorporated the USDA risks revisions in risk assessment and counseling. Staff has been providing technical assistance to local agencies when a need is identified or requested. See Functional Area 2 for explanation of Local agency liaison role. N/A IT report submitted Training scheduled for local agencies. Completed 4-2-2012. IT request developed and submitted January 2012. Changes to SWIS implemented 4-2-2012. At March 2012 Statewide meeting trained nutrition staff on revised and new criteria and system upgrades for implementation. Provided needed policy and procedure updates to NERO for review and approval. In process of planning for Sept. CTAAP/DPH joint teleconference to review WHO growth standards and WIC’s use of growth charts. 35 Objective Con’t 9.3 Implement updated Nutrition Risk Criteria by October 1, 2012. Strategies/Activities growth standards. As needed, provide targeted education to health care providers i.e. CTAAP teleconference on adaptation of WHO growth standards. Baseline Indicators Progress 36 CT WIC State Plan FY2013 Program Functional Area 10: Monitoring & QA Goal 10: Conduct on-site programmatic management and nutrition services reviews of local agencies to ensure compliance with Federal and State Regulations. Objective: 10.1 Monitor six (6) service regions including satellites. Objective: 10.2 Continue to evaluate applications of VENA principles in local operations and identify training and technical assistance needs. Objective: 10.3 Improve local agency compliance with monitoring findings (nutrition services and program operations) outcomes. Objective: 10.4 By September 30, 2012, implement a system to track, quantify and resolve vendor and participant complaints received by the State Office. Objective: 10.5 Implement off-year Local Agency Self-Assessments. Objective 10.1 Monitor six (6) service regions including satellites. Strategies/Activities • By end of 1st quarter, develop FY2012 monitoring schedule. • Conduct monitoring visits and exit conference within one (1) week of completion of fieldwork. • Prepare and submit program review reports to local agencies within thirty (30) calendar days of the last date of the program review. • Synthesize common review findings and responses to CAP in both nutrition services and program operations to update FFY13 Goals and Objectives, training and technical assistance plans. CT WIC State Plan FY2013 Baseline FFY11 LA monitoring schedule (See Objective 10.3) Indicators FY2012 Monitoring and review schedule tracking sheet. Number of visits and reports completed within timeframe indicated. Progress The FY2012 monitoring schedule was developed. Seven (7) local agencies were scheduled to be monitored this year. Four (4) have been monitored through June 2012. Exit conferences were not completed within 1 week due to local agency and State office scheduling conflicts and priorities, but were conducted at the first available opportunity. Monitoring reports for the Certification, Nutrition Services and Administrative components have been submitted to Management within the designated time frame. 37 10.2 Continue to evaluate applications of VENA principles in local operations and identify training and technical assistance needs. • Use revised monitoring tools to assess/report local agency staff progress in three (3) VENA competency areas to establish individual baselines for self improvement. • Summarize collected VENA best practices in areas of nutrition services and program operations, provide to all local agencies by Sept 30 each year. Provide time at State wide meetings to highlight best practices. • Continue convene the “VENA committee” monthly to address local agency training and technical assistance needs. -Subcommittee work to continue and evolve in FY 2012. Baselines from local agency reviews Ongoing process/tool evaluation and feedback from local agencies Evidence of LA application of VENA principles is reflected in monitoring reports. Results of monitoring visits are incorporated into technical assistance and training plans. VENA committee deliverables The VENA committee was renamed the ReNEW 2.0 committee to reflect the focus on quality services and expectations for nutrition services. Results of agencies monitored showed 90% of the staff from the demonstrated competency in the VENA skill of rapport building. About 75% of the staff demonstrated the VENA skill of critical thinking. However, 95% of staff from all of the agencies need work on developing competency in Positive Health Outcomes, specifically; allowing clients to set goal and the summarization of those goals. Best practice highlights will occur December 2012 as the June 2012 was cancelled due to funding cuts. Nutrition education subcommittee. See Nutrition Objective 2.8. re: development of lesson plans and Coordination of Services 7.1 re: SNAP Ed. collaboration. Translation to Spanish of Want a healthy baby? What you Need to Know about Cigarette Smoking Even if you Don’t Smoke into was completed. Scheduling subcommittee is in the process of working on updated language for WIC Public web site based on positive health outcomes. Documentation subcommittee: Completed work on 2 policies- Wait List and Foster Care. Also began work on statewide initiative to “PAUSE” to respond to monitoring funding re: positive health outcomes. CT WIC State Plan FY2013 38 10.3 Continue to improve local agency compliance with monitoring findings (nutrition services and program operations) outcomes. Provide targeted technical assistance interventions and training opportunities based on identified deficiencies. Continue to use timely distribution of FAQ’s after Statewide trainings to clarify nutrition services and program operations questions. As warranted, incorporate FAQ’s into Local Agency Policy and Procedure Manual TBD Review prior monitoring reports (See Objective 10.1) Reductions of repeat findings and observations in areas of nutrition services and program operations. Meetings are scheduled after each program review to connect the appropriate staff Nutritionist to provide technical assistance in the areas that were identified during the review. See Nutrition 2.0 for a description of the Local Agency Liaison process than began this fiscal year. Scheduling subcommittee tasks not accomplished this year included a series of “boosters” on policies that need clarification. First booster originally set for April on Alternate/Caretaker Policy, was moved back to August. 39 CT WIC State Plan FY2013 10.4 By September 30, 2012, implement a system to track, quantify and resolve vendor and participant complaints received by the State Office. Review existing complain tracking procedures. Based on review, refine or develop a centralized system and train appropriate State staff on how to record and track both vendor and participant complaints received by the State Office. Update State office procedures for taking, documenting and resolving vendor complaints re: participants and participant complaints re: local agencies or vendors. During monitoring, review local agency compliance with providing required information re: WIC check use at orientation, certification and re certifications. Topics covered by local staff should include: a) Food List/WIC approved foods b) Check Redemption procedures c) Consequences of Participant abuse As needed, work with Vendor Unit to incorporate any feedback into vendor training. Establish baseline. 10.5 Implement off-year Local Agency Self Assessments. Provide technical assistance to the five (5) local agencies that will implement the off-year Self-Assessment. Tools and guidance available in Policy and Procedure Manual. N/A CT WIC State Plan FY2013 Tally number of complaints received/documented at State office Decreased number of documented complaints at the State Office Documentation of acceptable resolution of complaint(s) Baseline and indicators TBD. All local agencies in off-year review cycle should include one (1) page summary from Self-Assessment in FY 2013 Local Agency Plan Vendors are reporting that participants are having difficulty with least expensive brand policy. Plan update to WIC Orientation Policy and Food Delivery Policy to address training issues. Documentation of all complaints from vendors against WIC participants received by the Local Program Operations Monitor has been kept on file for future reference. Resolution of all complaints was reached with the assistance and guidance of the Local Program Operations Monitors. During Administrative Reviews, the Program Monitor ensures all Local Agency Coordinators review a),b) & c) with staff and appropriate suggestions or recommendations made and documented in Administrative Review Reports. These three areas are also emphasized during State Orientation Training to new local agency staff. Off-year self assessments to began in 2012. 40 Program Functional Area 11: Fiscal Management Goal 11: Maximize the utilization of WIC food funds. Objective: 11.1 By September 30, 2012, expand the usage to 97% of all food dollars. Objective: 11.2 By September 30, 2012, revise Local Agency forms for required monthly reporting and required budgets and amendments. Objective: 11.3 By September 30, 2012, incorporate financial data into data quality activities to provide trend analysis on Connecticut WIC Objective 11.1 By September 30, 2012, expand the usage to 97% of all food dollars. Strategies/Activities Track LA expenditures monthly. • Meet with program directors. • Monitor food costs using the current CPI cost indicators. Baseline Budget/expenditure reconciliation. Indicators 100% of food dollars are accounted for. Progress Completed. Anticipate use of 97% of funds Maintained monthly meetings with local agency directors and provided training on expenditures. 11.2 By September 30, 2012, revise Local Agency forms for required monthly reporting and required budgets and amendments. Update current forms. • Change current format to Excel. • Join worksheets to eliminate repetitive information. Worksheets with instructions for Local Agency use with less errors. Less time to fill out forms and cut down on errors. Completed. Forms standardized and created in electronic format for all local agency expenditures, budget revisions and amendment requests. State agency staff (former local agency director) provided onsite training for new LA directors on reports. 11.3 By September 30, 2012, incorporate financial data into data quality activities to provide trend analysis on Connecticut WIC. Utilize financial data in trend analysis N/A Utilize financial trend data to drive program decisions Financial Management Completed. Monthly reports include trend analyses in state agency and local agency expenditures and food costs. CT WIC State Plan FY2013 41 Program Functional Area 12: Data Quality, Analysis & Reporting Goal 12: Strengthen data outputs for improved program planning, monitoring, evaluation and administration. Objective 12.1: Objective 12.2: Improve access to, and the utility and application of, WIC Program data: a. Build on current reports to provide enhanced, more accessible, data resources; b. Expand research/data analysis and reporting initiatives; c. Provide support in meeting other Program-related data needs. Contribute data inputs to help maximize strategic program coverage and effectiveness: a. Strengthen appropriate access to and delivery of program services; b. Ensure adequate access to vendor services, and vendor capacity to meet demand. Objective 12.1 Improve access to, and the utility and application of, WIC Program data: a. Build on current reports to provide enhanced, more accessible, data resources; Strategies/Activities 1. Prepare summary data tables, graphs to illustrate trends, and maps to compare distribution of selected variables; 2. CDC’s PNSS/PedNSS reports: post national, state and county data files to DPH/WIC website; share local-level files with field staff; Baseline - Monthly SWIS reports - Annual PNSS/ PedNSS reports - Biannual PC studies 3. USDA’s Program & Participant Characteristics: summarize and share pertinent information; Indicators Enhanced analysis and data presentations better meet USDA, state & local WIC agency needs for information on: WIC participation and caseload; Risk factors and referrals; Process and outcome objectives; Check issuance and redemption; Authorized vendors. 4. Censor data as appropriate in keeping with confidentiality regulations prior to sharing outside of WIC Program; 5. Post results or otherwise share selected data tables, graphs, trend reports and/or maps. Data tables, graphs and maps facilitate comparison of participant characteristics, risk factors, outcomes, etc.; Summary reports and improved data access result in less staff time invested in responding to routine requests. 6. Provide WIC Director with monthly summary stats covering participation, caseload, check issuance & redemption, program costs, and vendors, plus national WIC data and state population figures. CT WIC State Plan FY2013 Progress N/A 42 b. Expand research/data analysis and reporting initiatives; 1. Link WIC data file with the State’s birth file & Medicaid records: determine dual enrollment WIC/Medicaid; Prior studies 2. Project caseload, participation and program costs based on historical data and methodologies currently in use in other state WIC programs; More in-depth analyses help inform program decisions in support of key interventions and resource allocation; Local-level disparities are identified based on 2010 Census data, to better target program services & resources. Timely response to internal and external data requests; Surveys and presentations developed and/or technical assistance provided; Committees successfully complete assigned tasks. N/A 3. Update estimate of WIC eligibles, using most recent Census, birth and other data sources; 4. Map selected health, demographic and socioeconomic Census variables at the local level; compare results with current program coverage; 5. Identify and track risk factors contributing to poor program outcomes; 6. Evaluate associations between WIC participation and risk factors for poor birth outcomes. c. Provide support in meeting other Program-related data and reporting needs. 1. Respond to internal and external data requests; 2. Identify/develop relevant reference & training resources; Draft presentations for WIC Director, Nutrition staff, etc. Provide survey design, analysis, reporting, or technical assistance. Current SWIS reports Ongoing collaboration N/A 3. Collaborate in initiatives that benefit the State’s MCH population: Serve as the State’s PNSS/PedNSS Coordinator; Participate on DPH committees (MCH Block Grant, RFP and Publication Review Committees, etc.). CT WIC State Plan FY2013 43 12.2 Contribute data inputs to help maximize strategic program coverage and effectiveness: a. Strengthen appropriate access to and delivery of program services; 1. Monitor program services to help inform program planning and implementation efforts: Identify service gaps, priorities and opportunities; Track program outcomes and evaluate changes; Target resources to improve outcomes for those at highest risk. Current program services and resources Decisions to increase/decrease program services and resources are based on objective inputs; Risk factors and other variables associated with a given outcome or result are identified, providing enhanced criteria for targeting program interventions. N/A 2. Provide data/mapping inputs to help: (Re)locate clinic and vendor resources; Identify specific populations to target for outreach/promotional efforts and program services. b. Ensure adequate access to vendor services, and vendor capacity to meet demand. 1. Database development: Investigate need for data input form(s) to help facilitate data entry, increase efficiency & reduce error rates; Continue to identify priority data needs; build standardized queries to meet those needs; Provide monthly updates on authorized vendors to WIC Director and Vendor Management Unit. Current vendor database Currently authorized vendors WIC participation Vendor services and resources meet participant and program needs. 2. Vendor selection: Review the results of upcoming policy change in vendor selection from quarterly needs assessment to open enrollment, to determine effectiveness in meeting participant and program needs. 44 CT WIC State Plan FY2013 FFY 2013 GOALS AND OBJECTIVES CT WIC State Plan FY2013 Program Functional Area 1: Management and Organization Goal 1: Ensure program integrity, cost-effectiveness, quality of services and accountability in the delivery of nutrition services in the provision of food benefits. Objective 1.1: Implement a Memorandum of Understanding (MOU) with the State Department of Social Services (DSS) and Medicaid/Managed Care Providers to provide cross referrals and seamless and consistent services to WIC clients. Objective 1.2: Implement a Memorandum of Understanding (MOU) with the State Department of Children and Families (DCF) that addresses sharing of information between agencies. Objective 1.3: Refine and modify the CT WIC Annual Report by March 30, 2012. Objective 1.4: Provide a 1-2 day leadership and management workshop for LA Coordinators/Program Nutritionists/SA staff. Objective 1.5: Review, update and enhance WIC Continuity of Operations/Disaster Preparedness Plan Objective 1.6: Implement a Memorandum of Understanding (MOU) with the State Department of Social Services (DSS) to provide direct access to State agency WIC to obtain information. Objective 1.1 Implement a Memorandum of Understanding (MOU) with the State Department of Social Services (DSS) and Medicaid/Managed Care Providers to provide cross referrals and seamless and consistent services to WIC clients. 1.2 Implement a Memorandum of Understanding (MOU) with the State Department of Children and Families (DCF) that addresses sharing of information between agencies. CT WIC State Plan FY2013 Strategies/Activities Develop priorities and strategize multiprong approach regarding WIC business case. • Attend face-to-face meetings. • Identify specific liaisons from Connecticut’s Medicaid Program HUSKY and WIC • Develop a customized information packet. • Identify best practice collaborations at local agencies • Evaluate cross referral process and • Continue meeting with workgroup of agency representatives including the DPH Hearing Office • Develop an understanding of each agency’s requirements. • Develop MOU language and execute the agreements • Provide training to State and local agency staff. Baseline N/A Indicators Executed MOU and evidence of enhanced cross referral between WIC and HUSKY N/A Executed MOU Local and State Agency understanding of procedures Staff Director Nutrition Unit Director Nutrition Unit 45 1.3 Refine and modify the CT WIC Annual Report by March 30, 2013. 1.4 Provide a 1-2 day leadership and management workshop for Local Agency Coordinators/Program Nutritionists/SA staff. Coordinate end of the year reports with local agency outcomes measures for FFY2012 • Report enhanced data on statewide measures • Share human interest stories to highlight how WIC benefits participants • Incorporate operational information on • WIC to outside entities. Produce, distribute & post on WIC website. Secure facilitator, date, content and location (retreat location). • By end of 2nd quarter, develop and finalize contract • Attend logistics meetings. • Conduct meeting. • Evaluate and plan for future/ongoing training. N/A Annual report is published and distributed. Director Nutrition Unit Epidemiologist Special Projects N/A Workshop offered. Evaluation drives improvements in program operations Director Nutrition Unit Epidemiologist 1.5 Review, update and enhance WIC Continuity of Operations/Disaster Preparedness Plan. • Review and incorporate CT DPH COOP plan • Incorporate Disaster Preparedness Data Recovery (DPH IT) Plan components • Provide training to State and Local Agency staff N/A Updated Plan Director Nutrition Unit Vendor Unit IT Unit 1.6 Implement a Memorandum of Understanding (MOU) with the State Department of Social Services (DSS) to provide direct access for the State agency WIC to obtain information. Develop MOU language and execute the agreement. N/A Executed MOU Reduction in the time spent to obtain information from DSS Nutrition Unit CT WIC State Plan FY2013 Identify a State Department of Social Services (DSS) liaison to provide guidance and support to SA WIC Staff. Streamline DSS policies that affect WIC participants Establish a method of communication that will provide timely response to inquiry. 46 Program Functional Area 2: Nutrition Services and Breastfeeding Support & Promotion Goal 2: Improve the nutritional and overall health of WIC families in Connecticut and to increase the proportion of WIC-enrolled infants who are breastfed exclusively for at least 6 months. Objective: 2.1 At least 70% of pregnant women participating in the WIC Program for a minimum of 6 months gain appropriate weight. Objective: 2.2 The incidence of low birth weight (LBW) among infants whose mothers were on the WIC Program for at least six months during pregnancy does not exceed 6%. Objective: 2.3 The prevalence of anemia among children enrolled in the WIC Program for at least one year does not exceed 7.5%. Objective: 2.4 a. The prevalence rate of BMI > 85th percentile to < 95th percentile for children 2-5 years does not exceed 10%. b. The prevalence rate of BMI > 95th percentile for children 2-5 years of age does not exceed 15%. Objective: 2.5 At least 65% of infants enrolled in the WIC Program (have mothers who) initiate breastfeeding. Objective: 2.6 At least 10% of infants enrolled in the WIC Program are breastfed for 6 months or more. Objective: 2.7a Increase percentage of blood work results obtained and recorded in SWIS for postpartum women (result of deficient PC 2010 data findings) Objective: 2.7b Increase the percentage of bloodwork results obtained and recorded in SWIS for 18 month old children. Objective: 2.8 By FY 2014, all local agencies will use their outcome data to develop and implement targeted nutrition education lesson plans. Objective 2.1 At least 70% of pregnant women participating in the WIC Program for a minimum of 6 months gain appropriate weight. Strategies/Activities Continue to monitor trends and assess local agency staff skills in identifying women at risk for poor weight gain during pregnancy, and the effectiveness of education efforts on: • Weight gain during pregnancy • Nutrition during pregnancy • Smoking, ETOH/drug dangers • Referrals Expert speaker on domestic violence to speak at Statewide meeting. Develop content sheet specific to weight gain during pregnancy. Continue to monitor remaining local agencies for implementation of revised IOM pregnancy weight gain guidelines (NRC#10). CT WIC State Plan FY2013 Baseline 2013 WIC Goal: ≥70% FFY 2007: 66.9% Range: 56.2% - 82.4% FFY 2008: 65.7% Range: 57.3% - 78.4% FFY 2009: 67.2% Range: 57.9% - 76.5% FFY 2010: 66.4% Range: 42.3% - 81.3% FFY 2011: 68.8% Range: 59.0% - 81.1% FFY 2012: 72.2%* Range: 48.9% - 85.4% (* 9-month average) Source: CT SWIS, Outcome Objective #1 – Weight Gain during Pregnancy; quarterly reports, by federal fiscal year Indicators SWIS quarterly and annual reports. Referral & counterreferral reports. Results of monitoring show local agencies: Provide appropriate frequency of visit to monitor weight gain. Use effective educational methods and appropriate education materials. Change in trend data over time for low performing agencies. Once released, new My Plate materials and Tips for Pregnant Women will be utilized by local agencies for participant education and verified through monitoring and technical assistance visits. Staff assigned Nutrition Monitor Epidemiologist Nutrition Unit 47 Con’t 2.1 At least 70% of pregnant women participating in the WIC Program for a minimum of 6 months gain appropriate weight. 2.2 The incidence of low birth weight (LBW) among infants whose mothers were on the WIC Program for at least six months during pregnancy does not exceed 6%. 2.3 The prevalence of anemia among children enrolled in the WIC Program for at least one year does not exceed 7.5%. Orient local staff to new My Plate tips for Pregnant women. Review action steps of all local agency plans on maternal weight gain. Provide technical assistance (through Local agency Liaison) to the two (2) lowest performing local agencies identified for this objective. See Functional Area 12, Data Quality, Analysis and Reporting for information on these activities. Continue to monitor trends and improve weight gain during pregnancy. During observations monitor for nutritionist identification and discussion of contributing factors for this risk • History of LBW or pre-term delivery; • Mother’s age, etc. Review action steps of all local agency plans for LBW. Provide technical assistance to (through Local agency Liaison) the two (2) lowest performing agencies for this objective. See Functional Area 12, Data Quality, Analysis and Reporting for information on these activities. Monitor trends and assess local agency staff skills in identifying children at risk for anemia and effectiveness of education efforts on: • Iron-rich food sources, explanation of anemia/ risks, importance of timely blood work, appropriate iron supplementation and lowiron’s connection with risk for CT WIC State Plan FY2013 2013 WIC Goal: ≤ 6% FFY 2007: 5.9% Range: 1.5% - 9.4% FFY 2008: 5.9% Range: 3.6% - 9.5% FFY 2009: 5.8% Range: 2.6% - 9.1% FFY 2010: 5.8% Range: 1.8% - 10.0% FFY 2011: 6.1% Range: 3.5% - 8.5% FFY 2012: 6.0%* Range: 2.1% - 8.7% (* 9-month average) SWIS quarterly and annual reports Reduce health disparities. Nutrition Monitoring staff Epidemiologist Nutrition Unit Results of monitoring show local agencies are using effective educational methods and appropriate education materials. Change in trend data over time for low performing agencies. Source: CT SWIS, Outcome Objective #2 – LBW Incidence; quarterly reports, by federal fiscal year. 2013 WIC Goal: ≤ 7.5% FFY 2007: 8.1% Range: 2.7% - 12.5% FFY 2008: 7.9% Range: 3.4% - 10.4% FFY 2009: 7.6% Range: 3.9% - 10.5% FFY 2010: 6.8% Range: 2.4% - 10.6% SWIS quarterly and annual reports Results of monitoring show local agencies are using effective educational methods and appropriate education materials Nutrition monitoring staff Epidemiologist Nutrition Unit FFY 2011: 6.8% Range: 4.1% - 8.8% FFY 2012: 7.7%* Range: 4.4% - 10.3% Change in trend data over time for low performing agencies 48 Con’t 2.3 The prevalence of anemia among children enrolled in the WIC Program for at least one year does not exceed 7.5%. 2.4 a. The prevalence of BMI > 85%ile to < 95%ile for children 2-5 years of age does not exceed 10%. b. The prevalence of BMI > 95%ile for children 2-5 years of age does not exceed 15%. lead poisoning. • Making appropriate referrals and follow-up. Monitor for local agency incorporation of anemia content Sheet messages into individual education sessions. Work with IT staff to incorporate BMI as a new quarterly outcome objective for FFY 2012, and to generate the needed data by local agency, age group, race/ethnicity and town of residence. Monitor for local agency incorporation of content sheets targeted to prevent obesity- fruit and vegetable intake, physical activity and introduction to solids. Orient local agencies to the revised My Plate tips for toddlers brochure/concepts See Functional Area 12, Data Quality, Analysis and Reporting for information on IT and Epi specific activities related to this objective. Monitor for local agencies inclusion of new nutrition outcome objectives in local agency plans. Provide training and guidance to local agencies on incorporating measurable strategies into their plans. (* 9-month average) Source: CT SWIS, Outcome Objective #4 – Anemia Rate; quarterly reports, by federal fiscal year. WIC 2013 Goals: SWIS quarterly and annual reports CT WIC Program Data: BMI ≥ 85 & < 95%ile: Childhood BMI or obesity Outcome Objective is included in FY 2013 State Plan and is included in all local agency plans. < 10% 85-95th%ile > 15% 95th %ile FFY 2007: 9.7% Range: 9.2% - 10.2% FFY 2008: 9.5% Range: 9.1% - 9.8% FFY 2009: 9.7% Range: 9.5% - 10.0% FFY 2010: 9.3% Range: 9.0% - 9.5% FFY 2011: 9.8% Range: 9.4% - 10.1% Nutrition monitoring staff Epidemiologist IT staff Nutrition Unit Once released, new My Plate materials and Tips for Toddlers will be utilized by local agencies for participant education and verified through monitoring and technical assistance visits. FFY 2012: 9.8% * Range: 9.6% - 10.0% (* 7-month average) CDC/PedNSS Data: BMI: 85<95 ≥95 CY 1985: 11.0% 6.7% CY 1990: 14.5% 11.0% CY 1995: 15.0% 13.2% CY 2000: 17.9% 16.6% CY 2005: 16.3% 16.6% CY 2006: 16.5% 16.2% CY 2007: 16.0% 16.2% CY 2008: 15.7% 15.5% CY 2009: 15.4% 16.0% CY 2010: 14.9% 15.8% Source: CDC, Pediatric Nutrition Surveillance System. Connecticut, 2010 (calendar year); Table 12C. 49 CT WIC State Plan FY2013 2.5 At least 65% of infants enrolled in the WIC Program (have mothers who) initiate breastfeeding. 2.6 At least 10% infants enrolled in the WIC Program are breastfed for 6 months or more. Coordinate Statewide WIC breastfeeding promotion and support activities. WIC BF Committee meeting and activities. - Meet quarterly in person and/or via conference call - Using LS Grow and Glow curriculum, develop consistent content for breastfeeding group education. -Revise, as needed Connecticut Breastfeeding Guidelines and provide training to local staff and incorporate updates into State Plan. Include requirement for annual breast pump demonstration training for all local staff that issue breast pumps. Provide technical assistance to LAs in implementing WIC BF guidelines and annual BF promotion plans. - Conduct three (3) breastfeeding focused site reviews in FY 2012. (Schedule reviews by end of first quarter). Continue to monitor implementation of four (4) breastfeeding content sheets. Revise content sheet focused on pumping for workplace based on recent LLL conference content. Monitor for incorporation of strategies to increase breastfeeding duration in local agency plans. Include revised measure as part of LAP performance measures. -Address data quality issue re; duration CT WIC State Plan FY2013 WIC 2013 Goal: ≥ 65% HP 2020: 81.9% FFY 2006: 57.2% Range: 43.5% - 88.4% FFY 2007: 59.1% Range: 45.0% - 87.6% FFY 2008: 61.3% Range: 49.3% - 89.0% FFY 2009: 63.7% Range: 52.1% - 88.9% FFY 2011: 65.0% Range: 49.8% - 88.4% FFY 2012: 68.7%* Range: 48.5% - 91.4% Documentation of improved compliance with guidelines per technical assistance reviews and monitoring reports. More than half of agencies visited will meet or exceed performance standards. Breastfeeding Unit Epidemiologist and IT staff Record of meetings and joint tasks or activities accomplished from CBC, CT Chapter of the American Academy of Pediatrics (CT-AAP) and other groups. (* 9-month average) Source: CT SWIS, Outcome Objective #3a – BF Initiation Rate; quarterly reports by federal fiscal year. CT State BF Initiation: Birth year 2000: 86.4% Birth year 2001: 71.2% Birth year 2002: 75.0% Birth year 2003: 76.2% Birth year 2004: 78.1% Birth year 2005: 74.5% Source: CDC. Provisional Data, National Immunization Survey, 2005 Births. 2008. (Note: NIS covers the general population, while PedNSS includes only lowincome population in federally funded programs.) WIC 2013 Goal: 10% HP 2020 Goal: 60.9% WIC Program Data: FFY 2006: 7.0% Range: 0.2% - 22.7% FFY 2007: 7.8% Range: 0.5% - 18.9% FFY 2008: 8.0% Range: 2.9% - 16.0% FFY 2009: 9.4% CDC’s Pediatric Nutrition Surveillance System (PedNSS) reports [Connecticut reports are Breastfeeding Unit Epidemiologist derived entirely from CT’s Statewide WIC Information System – SWIS]. Record of meetings and technical assistance provided to local agencies, local agency 50 Con’t 2.6 At least 10% infants enrolled in the WIC Program are breastfed for 6 months or more. Manage WIC Breastfeeding Peer Counseling Programs. • Monitor performance of Hartford and New Haven programs. Submit reports to USDA. • Continue to implement pilots and refine protocols. -Begin to analyze data for pilot sites. Follow-up on implementation of USDA’s Loving Support: Building Breastfeeding Competencies initiative. • Test revised portions of the Grow & Glow modules into biannual State orientations. Continue to lead sustainability of Connecticut Breastfeeding Initiative with DPH partners. Convene 4 meetings of the DPH internal breastfeeding committee in FY 2013. -Update day care breastfeeding training Coordinate at least one (1) Breastfeeding-focused CT-AAP teleconference in FY 2012. Actively participate in the CT Breastfeeding Coalition (CBC). With Epi and IT Units, review calculation of breastfeeding duration, and make any necessary adjustments. See Functional Area 12, Data Quality, Analysis and Reporting for information on IT and Epi specific activities related to this objective. Range: 2.8% - 15.7% FFY 2010: 7.0% Range: 1.1% - 17.2% Source: CT SWIS, Outcome Objective #3b - BF Duration; quarterly reports, by federal fiscal year. NIS Study Data: State 6-mos BF Duration: Birth year 2000: 45.7% Birth year 2001: 40.3% Birth year 2002: 33.8% Birth year 2003: 40.8% Birth year 2004: 43.0% Birth year 2005: 42.9% BF coordinators and CT Breastfeeding Coalition Quarterly activity and expenditure reports from contractors, including # of women enrolled and duration rates. Source: CDC. Provisional Data, National Immunization Survey, 2005 Births. 2008. (Note: NIS covers the general population, while PedNSS includes only lowincome population.) CDC/PedNSS Data: By Calendar Year: CY 1985: 7.2% CY 1990: 8.3% CY 1995: 11.3% CY 2000: 15.8% CY 2002: 23.8% CY 2004: 22.9% CY 2006: 24.6% CY 2008: 24.4% CY 2010: 27.0% By Race/Eth. & Year: Hispanic, by Year CY 2001: 24.6% CY 2003: 26.6% CY 2005: 26.1% CY 2007: 27.6% CY 2009: 29.9% CY 2010: 29.4% NH Black, by Year CY CY CY CY CY 2001: 2003: 2005: 2007: 2009: 23.1% 20.5% 17.8% 21.7% 23.6% CT WIC State Plan FY2013 51 Con’t 2.6 At least 10% infants enrolled in the WIC Program are breastfed for 6 months or more. 2.7 a Increase percentage of bloodwork results obtained and recorded in SWIS for postpartum women (result of deficient PC 2010 data findings). 2.7 b Increase percentage of bloodwork results obtained and recorded in SWIS for 18 month old children. 2.8 By FY 2014, all local agencies will use outcome data to develop targeted nutrition education lessons plans. CY 2010: 25.5% NH White, by Year CY CY CY CY CY CY 2001: 2003: 2005: 2007: 2009: 2010: 20.2% 18.1% 21.7% 19.5% 23.1% 23.1% Source: CDC, Pediatric Nutrition Surveillance System. CT, 2010 (calendar year); Table 13C. Continue to identify local agency with issues obtaining current bloodwork for postpartum participants. Develop solutions to improve access for postpartum women to obtain bloodwork. Monitor 10 additional postpartum files targeting bloodwork data. Continue to identify local agencies with issues obtaining 15-18 month bloodwork results for 18 month old children. Identify Health Care Providers (HCP) not in compliance with the ESPDT periodicity schedule. Work with DSS liaison and HCP’s to resolve. Develop workshop and train local agency staff on how to use local agency outcome data and ad hoc SWIS reports to drive provision of nutrition education and development of lesson plans. State staff will review FY 2013 local agency plans for objectives/strategies that utilize one or more core nutrition education lesson plans developed in 2012. During technical assistance visits and routine monitoring assess CT WIC State Plan FY2013 PC error reports data? PC 2012 Data, CDC’s Pediatric Nutrition Surveillance System (PedNSS) reports Chart audit results Monitoring staff Epidemiologist Nutrition Unit Increase the percentage of bloodwork results obtained Decrease in the number of reported cases of HCP’s noncompliance Quarterly outcome reports and SWIS reports 2012 and 2013 Local agency plans Local agencies report on implementation of at least one lesson plan in 2012 (using one of 5 core lesson plans). Local agencies will incorporate strategies in LAP to fully implement local agency customized nutrition education by 2014. Nutrition Education subcommittee Nutrition Unit Nutrition Monitoring staff 52 Con’t 2.8 By FY 2014, all local agencies will use outcome data to develop targeted nutrition education lessons plans. proficiency in local agency nutrition staff’s ability to develop targeted lesson plans using outcome data Monitor for implementation of one of the five core lesson plans. Twice a year, discuss successes and/or challenges with local agency implementation lesson plans as result of technical assistance and monitoring visits, to troubleshoot and identify best practices for replication. CT WIC State Plan FY2013 53 Program Functional Area 3: FOOD DELIVERY AND FOOD INSTRUMENT ACCOUNTABILITY Goal 3: To improve food delivery operations at the state and local agency level. Objective: Objective: Objective: Objective: Objective: 3.1 3.2 3.3 3.4 3.5 Increase to 100% timely monthly receipt of local agency unused check stock inventory reports. Decrease the number of rejected checks for selected rejection reasons by 10%. Make changes to food packages and eligible foods in response to Final Rule for Revisions in the WIC Food Packages. Improve access to special formulas at retail stores. Complete transition of previous Food Delivery Coordinator duties among remaining Food Delivery/Vendor Management Staff. Objective 3.1 Increase to 100% timely monthly receipt of local agency unused check stock inventory reports. 3.2 Decrease the number of rejected checks for selected rejection reasons by 10%. Strategies/Activities An appointment was sent in FY12 to each Coordinator’s Outlook calendars that the report is due on the 15th of every month with a reminder 3 days before. An email will be sent to LA if the report is not received by the middle of the month. Non-compliant local agencies will continue to be cited and monitored for future compliance during management evaluations. Baseline Currently an average of 92% compliance Indicators Compliance of local agency reports. Decreased finding of noncompliance in management evaluation reports. Staff assigned Food Delivery Unit N/A Monitoring report findings. Results of the unused check stock inventory report spreadsheet. Program Monitor Provide written policy to LAs on handling voided in-hand checks and the immediate detection of mis-numbered checks that lead to rejections. Follow up on agencies based on reports. Rejected checks due to distribution of checks that were voided-in-hand or mis-numbered Reduction in the number of checks rejected due to mis-numbering and checks voided-in-hand, but distributed to participants. Food Delivery Unit Amendments to the State’s banking contract were provided in FY11. Included was a request to allow vendors to place the vendor stamp in the endorsement area of the back of the WIC check as well as the required placement on the front of the check. Rejected checks due to illegible vendor stamp Reduction in the number of checks rejected due to the bank’s inability to read the stamped vendor numbers. Store adherence of endorsement rule. Vendor Unit CT WIC State Plan FY2013 54 3.3 Make changes to food packages and eligible foods in response to Final Rule for Revisions in the WIC Food Packages. Changes to food list, minimum inventory, pricing and monitoring reports will be needed. Final rule delayed in 2011; expected in FY13. Emails and information submitted to the State WIC Office for approval in Connecticut. 2nd Quarter of FY13 New Food List is printed. 2nd Quarter of FY13 New Agreements are printed and executed. If needed, provide bulletin for training on new regulations or procedures. 2nd Quarter of FY13 Bulletins sent to all WIC authorized vendors and farmers. If needed, communicate necessary SWIS changes in food packages to IT. 2nd Quarter of FY13 Changes have been tested. If needed, provide updates to local agencies regarding any new policies, educational materials, and changes to the usage of the fruit & vegetable check. If needed, notify wholesale distributors of updates to food packages, new food items, and minimum inventory requirements. Issuance of all Connecticut WIC checks reflecting full implementation of the new food package changes for all categories of WIC participants. 2nd Quarter of FY13 Numbered memo sent. 2nd Quarter of FY13 Mailing list. 2nd Quarter of FY13 Issued check files. New peer group maximums are sent to the bank. Review the influx of submissions from manufacturers and distributors on product nutrition labels, statewide availability and retail costs Revise the Connecticut WIC approved food list, the maximum monthly quantities in food packages and forms to be used in food delivery at the local agency (e.g. medical documentation). Secure and adapt education materials. If needed, finalize the vendor and farmer agreements to update the minimum inventory requirements and the procedures for processing the fruit & vegetable check. CT WIC State Plan FY2013 Food Delivery Unit Vendor Unit Nutrition Unit 55 3.4 Improve access to special formulas at retail stores. 3.5 Complete transition of previous Food Delivery Coordinator duties among remaining Food Delivery/Vendor Management staff. 3.6 Measure program integrity through investigation of the sale of food benefits and formula. 3.7 Improve program integrity through sanctions for the sale of food benefits and formula. Revise draft document to update names and sizes of all CT approved formulas and medical foods for participant/local agencies to order formula at authorized WIC vendor locations. Distribute document to local agencies for participant use, as well as authorized vendors and their corporate offices. 1st Quarter of FY13 Facilitate WIC participants’ obtaining products that are printed on their WIC checks in a timely manner. 1st Quarter of FY13 Vendors are able to better serve WIC customers needing formulas and medical foods. Include the document in printed annual training materials and interactive training presentations. 2nd – 4th Quarters of FY13 Make vendors aware that the tool exists to help serve WIC customers’ needs. Duties of the WIC Vendor Specialist will be dispersed among vendor management staff that includes tracking the review process, distribution of monthly authorized vendor list to local agencies and website, and revisions to the WIC Approved Food List. 1st Quarter of FY13 Vendor management lead is attending reviews and acting as technical advisor to the review officer, authorization status of vendors change on a monthly basis and supply of current food list is running low. Lead in food delivery/vendor management will oversee unused check stock inventory and check deliveries on an ongoing basis 1st Quarter of FY13 Above 50 percent determinations, average prices paid to all vendors, and management of not-to-exceed prices for A50 stores Monitor for and respond to ads offering commonly issued food benefits and/or formula. 1st Quarter of FY13 Unused check stock inventory reports are received each month from local agencies, usage is tracked and additional check stock is ordered every 2 months Test of means report, 4th Quarter report due to USDA by February 1, 2013. Comply with sanction and claims requirements for participants that have offered for sale/sold or improperly disposed of food benefits and/or formula CT WIC State Plan FY2013 Food Delivery Unit Vendor Unit Food Delivery Unit Vendor Unit Currently this activity is performed three times per week Documentation of the number of the incidences of WIC Participant involvement and the number of ads responded to will measure the degree of participant involvement. Food Delivery Unit Vendor Unit Currently this activity is performed each time there is sufficient documentation of participant involvement. Frequency of participant sanctions and claims issued for this violation will temporarily increase. Food Delivery Unit Vendor Unit 56 Program Functional Area 4: Vendor Management Goal 4: To improve communication and effectiveness in Vendor Management. Objective: Objective: Objective: Objective: 4.1 4.2 4.3 4.4 Enhance the WIC website and email usage to provide important vendor-related information. Increase from 10% to 50% the number of compliance investigations that are initiated and completed within FY 2013. Utilize a Microsoft Access database to improve the tracking of application/authorization processes. Investigate and determine the process for changing State Regulations. Objective 4.1 Enhance the WIC website and email usage to provide important vendorrelated information. Strategies/Activities Indicators Maintain links to federal regulations, vendor authorization process, vendor agreement and a monthly list of currently authorized vendors. 2012 information Changes are needed for updated information. Email address is now part of our letterhead to encourage submission of information and questions to the program. Monitor vendors’ usage of email as a first point of contact and monitor compliance for each vendor ownership having an email address. 15% of vendors in FY12 An increase in the number of emails received from vendors. Only applicant vendors are required to use email to respond to open enrollment postings. 33% of authorized stores provide an email address. Email usage for bulletins/ communications were mostly to corporations and farmers in FY12. Website’s potential is only partially realized. Increased utilization of the website by vendors to obtain relevant information. Reduction in calls for information that is provided on the website. Utilize distribution list of vendors’ email addresses to improve communications and encourage website usage. Evaluate effectiveness of the website content and revise according to the needs of both the state and vendors, if deemed appropriate for publication. CT WIC State Plan FY2013 Baseline Staff assigned Vendor Unit Increased communications to all vendors via email. Updates to website information based on vendor feedback/questions. Reduction in calls received for routine information. Increased number of state staff referrals to the website for information. 57 4.2 Increase from 10% to 50% the number of compliance investigations that are initiated and completed within FY 13. 4.3 Expand Access databases to improve the tracking of application/authorization processes. During the first quarter, select stores to be investigated, have contractor perform initial compliance buys and DPH to review compliance buy reports. During the second quarter, send sanction letters and confirm receipt of notice of violations if applicable. During the third quarter, have contractor perform follow up compliance buys as needed. During the fourth quarter, send additional sanction letters if applicable. Develop additional forms that feed data into a vendor management database. Obtain pertinent training for all vendor management staff through in-service classes. CT WIC State Plan FY2013 10% As of October 1, 2012, 5% of the authorized vendors are investigated early in the fiscal year. N/A Results of the compliance buy that identifies if violations occurred which may necessitate a sanction letter. N/A Additional compliance buys performed on vendors that would have received warnings. At least 50% of investigations are deemed to be complete. N/A 2 databases being used, one as a table and source document and one as a form for data entry for monitoring, tracking of applications and stamps. Minimal knowledge of and experience with Microsoft Access Query the database for vendors included in each aspect of the application process (e.g. renewals, new stores under the same ownership, stores in the authorization process, etc.). Vendor application information is in an Excel documents. Utilize queries to track progress and determine if internal deadlines will be met or need to be adjusted. Some currently tracked through multiple Excel spreadsheets, others through Access database. Standardized queries and reports developed to meet VM staff needs. Vendor Unit Vendor Unit “How-To” fact sheets and other resources developed and shared with Vendor Management staff. Expansion of staff knowledge base. Vendor database tracks and reports out vendor management activities by phase, and increases the efficiency and accuracy of the vendor application, selection and authorization process, from a store’s initial request, through training, and determination of authorization. Increased efficiency in managing yearly application/authorization tasks. 58 Con’t 4.3 Expand Access databases to improve the tracking of application/authorization processes. Utilize database to facilitate updating information and preparing the annual TIP report (The Integrity Profile). Currently tracked through the Access table and Excel spreadsheets. Decrease in time to complete the TIP report. 4.4 Investigate and determine the process for changing State Regulations. Review Federal Regulations and current State regulations to identify areas that are inconsistent. Identify and document the expedited process for changing certain regulations and determine when it is (for what changes) appropriate to use this process. Explore the regular process for changing regulations and determine which required changes can be completed using this process. Vendor monitors will perform inspections and complete a written inspection report for authorized vendors. Current state regulations have been in effect since June 1998. Vendor Management policies are compliant with federal regulations, but have changed since state regulations were last updated. Vendor Unit 56% Baseline percentage will increase to 85% Vendor Unit Currently, vendors receive a follow up monitoring visit after documentation of state agency sanctions when time and staff resources allow. Any vendor that fails to meet the minimum inventory requirements during a routine monitoring visit will meet minimum the minimum inventory requirements during a follow up inspection prior to the end of that fiscal year. Vendor Unit 4.5 Increase from 56% to 85% the number of Authorized Vendors that receive on site monitoring visits in FY13. 4.6 Improve vendor compliance with minimum inventory requirements through follow up inspections. Any vendor that fails to meet the minimum inventory requirements during a routine monitoring visit shall receive a follow up monitoring visit after documentation of state agency sanctions. 59 CT WIC State Plan FY2013 Program Functional Area 5: Management Information Systems Goal 5: To maintain and enhance the WIC IT infrastructure. Objective: Objective: Objective: Objective: Objective: Objective: Objective: Objective Objective: 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 Implement solutions or new technologies to address changes in USDA regulations and/or state policy. Establish a master schedule for all WIC IT projects Continue the mainframe cost containment initiative. Procure an MIS and EBT solution for Connecticut. Move towards a self service reporting environment for regular WIC information needs Prepare for data migration and conversion to new MIS Develop a new MIS equipment obsolescence plan. Increase staff knowledge and utilization of current IT languages, tools and techniques Implement new technologies to enhance productivity or system security. Objective 5.1 Implement solutions or new technologies to address changes in USDA regulations and/or state policy. 5.2 Establish a master schedule of all WIC IT projects. Strategies/Activities Re-program SWIS as required to accommodate changes in regulations and/or policy. Deploy new technologies as required by changes in USDA and/or DoIT policies. Create and maintain a master schedule of IT activities. Baseline NewSWIS version 1.61 Indicators Staff Assigned IT Section Chief IT Supervisor All projects independent Master calendar created and maintained. IT Section Chief IT Supervisor 5.3 Continue the mainframe cost containment initiative. Monitor various processes for usage, printing, disk and tape storage costs. Move certain processes from mainframe to server. Remove obsolete report processes. Mainframe costs from prior year for given month Maintain MF cost in report of MIS Cost Survey Feb 2010. Technical Analyst II 5.4 Procure an MIS and EBT solution for Connecticut. Complete BEST required documents for system selection. Complete IAPD. Issue RFP. Award RFP. Feasibility Study and related documents BEST Approval. USDA Approval. RFPs Issued. RFPS Awarded. Director IT Section Chief IT Supervisor CT WIC State Plan FY2013 60 5.5 Move towards a self service reporting environment for regular WIC information needs. Identify standard reports for automatic creation. Look at intranet or report server options for distribution. Look at adhoc reporting capabilities for common requests. 5.6 Prepare for data migration and conversion to new MIS. Updating SWIS technical documentation. Create data dictionary. Purging old data. Data scrubbing. Manual cleanup by Las. Conversion strategy for phased rollout. Maintain operational status of IT infrastructure by providing timely service or replacement of defective equipment. Maintain inventory of IT equipment and implement. Replacement plans as dictated by resources and budget. Create upgrade/refresh schedule for next 18 months. Include professional development as part of annual review criteria. Lunch and learn sessions to share knowledge. WIKI or sharepoint sites for all system. 5.7 Develop a new MIS equipment obsolescence plan. 5.8 Increase staff knowledge and utilization of current Programming languages, tools and techniques. 5.9 Implement new technologies to enhance productivity or system security. Deploy new technologies to enhance productivity or system security. Larger or dual monitors. Intranet or Sharepoint for organizing information. Implement LINC (MS Communicator) for interagency communication. New switches for remote site admin. As defined by CDC, USDA, program requirements and epidemiologist work. Current IT infrastructure Current knowledge and tools Current IT infrastructure Standard report list with creation calendar. Pilot intranet or report server. Pilot Adhoc reporting capability. IT Section Chief IT Supervisor System documentation. Data dictionary. Old data purged. Data scrubbed. Conversion strategy document. Technical Analyst II LAs are able to provide adequate services to participants during equipment downtime. End of Life determined for all key IT assets. Publically available upgrade/refresh schedule for next 18 months. Increased professional development. Lunch and learn sessions. Build out of WIKI or SharePoint sites for all systems. New switches Technical Analyst II IT Section Chief IT Supervisor IT Section Chief IT Supervisor 61 CT WIC State Plan FY2013 Program Functional Area 6: Caseload Management/Outreach Goal 6: Effectively reach all eligible individuals as resources allow, and achieve the maximum caseload capacity to serve the greatest number of women, infants and children. Objective 6.1: Objective 6.2: By September 30, 2013, increase by 2% enrollment of high-risk applicants by evaluating local agency targeted outreach activities for these populations. By September 30, 2013, decrease the no-show rate by 5% using baseline established by each local agency as reference point. Objective 6.1 By September 30, 2012, increase by 2% enrollment of high-risk applicants by evaluating local agency targeted outreach activities for these populations. Strategies/Activities 1st trimester enrollment of pregnant women is greater or equal to 50%. Determine feasibility of tracking early enrollment of infants within first six weeks of life. If feasible, develop report to provide data to local agencies for program evaluation and planning. Baseline 2013 WIC Goal: 50% FY 2006: 49.5% Range: 16.4-74.9% FY 2007: 47.9% Range: 19.4-62.2% FY 2008: 48.2% Range: 25.6-57.6% FY 2009: 50.3% Range: 26.2-66.3% Indicators SWIS Process Objective Report (FY 2012 Range should be 39.3%71.5%) Staff assigned Program Monitor Baseline or indicator to be established. Data points of infant’s birth date and certification date can be use to generate report FY 2010: 50.9% Range: 30.7% - 67.4% FY 2011: 53.6% Range: 40.8% - 66.2% FFY 2012: 53.5%* Range: 39.9% - 71.5% (* 9-month average) Source: CT SWIS, Process Objective 1 – 1st Trimester Entry into WIC, quarterly report CT WIC State Plan FY2013 62 Con’t 6.1 By September 30, 2013, increase by 2% enrollment of high-risk applicants by evaluating local agency targeted outreach activities for these populations. 6.2 By September 30, 2013, decrease the no-show rate by 5% using established local agency baseline. Review all local agency plans for evaluation of outcomes of prior year’s outreach activities and changes that were incorporated for future outreach activities based on reported results. Quantitative assessment of each Outreach Activity carried out reported in local agency plan. Program Monitor Nutrition Monitor Verification that all local agencies are rate tracking, analyzing and implementing and effective strategies to reduce no-show rate. Program Monitor During monitoring and for those agencies that are conducting Self-assessments, review current outreach strategies with local staff to ensure outreach plan remains relevant. Provide on-site technical assistance as needed. Ensure continued effective implementation of daily appointment reminder calls. Develop an automated, standardized report for tracking no-show rate. TBD Identify lowest performing local agency and provide targeted technical assistance (in coordination with Local agency Liaison) to improve outcomes. E.g. sharing of successful strategies from other agencies. CT WIC State Plan FY2013 63 Program Functional Area 7: Coordination of Services Goal 7: Strengthen coordination of information and resources with other Connecticut State Agencies to respond to the needs of the WIC clients. Objective: 7.1 Maintain active coordination with at least 75% of identified key partners Objective: 7.2 In 90% of reviewed charts/clinic observations during monitoring visits appropriate mandated and targeted referrals were made. Objective 7.3 Determine the effectiveness of current satellite sites. Objective 7.1 Maintain coordination with at least 75% of identified key partners. Strategies/Activities Continue to actively participate in State level MCH Task Forces, Head Start, Oral Health, Lead Prevention/Immunization programs, HUSKY (Medicaid Managed Care) and DSS. Continue to coordinate with DPH Food Protection Program, Consumer Protection Agency, and DPH Environmental Epidemiology. CT was awarded a FY 2011 USDA WIC Special Project Concept Paper Development Grant to develop a full-grant proposal for the Connecticut WIC and Head Start Cross-Program Collaboration Project. A courtesy copy of the final Full Grant proposal will be sent to NERO upon submission for the FY 2013 SPG Full Grant award. In the interim, UCONN and State staff are investigating other funding sources for a scaled back version of project to increase chances of funding in 2013 or 2014. Continue SNAP Ed/WIC Program LYF/FYF Collaborative Initiative: Coordinate with SNAP Ed as needed with local agency workshop/display plans. Incorporate routine use of SNAP Ed recipes in WIC education/resources used. Incorporate USDA core messages in WIC nutrition education where indicated. Identify other State partners serving similar populations to improve coordination of services. CT WIC State Plan FY2013 Baseline Letters of agreement or MOU’s with Medicaid Managed Care (HUSKY), Immunization, SNAP-Ed, Child Enforcement Agency and TANF. Policy and procedures on formula safety and recall MOA with UCONN for full grant development Indicators Improvement of service delivery to mutual clients Staff assigned Nutrition Unit Program Operations Ensure safety of food/formula provided to WIC participants. Current recommendations or guidelines relevant to WIC participants are sent to local WIC agencies. Final WIC SPG Full grant is submitted and funded. Successful SNAP Ed workshops/displays at local agencies based on evaluations and feedback from SNAP Ed/local agencies/students SNAP-Ed Recipes utilized at local WIC agencies. FNS Core Messages incorporated into WIC Nutrition Education lesson plans and/or other education materials 64 Objective 7.2 In 90% of reviewed charts/observations during monitoring visits appropriate mandated and targeted referrals were made. Strategies/Activities During reviews, assess local agency utilization of revised referral codes and referral policy and procedures. • Update revised policies/procedures if indicated. • Provide review of updated policies and procedures at Statewide Meetings as needed. Monitoring staff to continue to track during site reviews. More emphasis placed on referral and outreach goals and outcomes in local agency planning process. 7.3 Determine the effectiveness of current satellite sites. Collect data on satellite site operations • Location of satellite sites • Number of clients served • Hours of operation CT WIC State Plan FY2013 Baseline N/A Indicators Improved local level coordination with staff regarding referrals. All local agencies will utilize a Local Community Resource Guide on a regular basis. Improved documentation on provision of referrals and follow up. Improved consistency of use of referral codes by LA’s. LA’s develop internal process for tracking referrals (providing and following up). Reduction in review findings related to referrals. Staff assigned Monitoring Unit Nutrition Monitor Nutrition Monitor Local agency Liaison 65 Program Functional Area 8: Civil Rights Goal 8: Establish and administer policies and procedures that ensure client-oriented customer friendly service environment for all applicants and participants and comply with Racial/Ethnic Federal mandate to ensure uniformity and comparability in the collection and use of data as required by OMB standards. Objective: 8.1 Objective: 8.2 Objective: 8.3 Verify 100% of local agencies are in compliance with use of non-discrimination statement requirements and OMB racial/ethnic data collection standards. Ensure annual civil rights training for state and local agency staff By 2014, implement web-based Civil Rights Training for State and Local agency staff. Objective 8.1 Verify 100% of local agencies are in compliance with use of non-discrimination statement requirements and OMB racial/ethnic data collection standards. Strategies/Activities Request copies of LA developed brochures, handbooks, and/or other publications and review for proper usage of the non-discrimination statement. Baseline Ongoing Indicators Each brochure and handout will contain the non-discrimination statement. Staff assigned Monitoring Unit Monitor to verify that Racial/Ethnic Data Collection procedures followed at local agencies during FY 2012 reviews. Regulatory compliance as evidenced in monitoring reports. 8.2 Conduct annual civil rights training for local agency staff. Update and train all State and local staff on revised discrimination complaint procedures. Web-based or some type of interactive training is implemented at local agencies. Monitoring Unit State and Local Agency staff will be issued a certificate upon completion of Civil Rights Training Monitoring Unit Explore a web-based, interactive module for annual civil rights training. • Review existing options • Recommendations to management by second quarter • Implement new training model in third or forth quarter of 2012. 8.3 Implement web-based Civil Rights Training for State and Local agency staff. CT WIC State Plan FY2013 Review California Webinar and adapt to Connecticut. 66 Program Functional Area 9: Certification & Eligibility Goal 9: Improve and maintain program integrity in the areas of certification and eligibility. Objective: Objective: Objective: Objective: 9.1 90% of special formula procedures observed in reviews were accurate and complete. 9.2 Monitor local agency implementation updated risk criteria. 9.3 100% of participants (children, postpartum and breastfeeding women) receive targeted exit counseling. 9.4 Implement and track 1- year certification for children. Objective 9.1 90% of special formula procedures during monitoring were accurate and complete. Strategies/Activities Continue to evaluate local compliance with special formula procedures during nutrition services monitoring • Review special formula log during reviews for accuracy and to determine frequency of insufficient “medical rationale” • Review WIC infant formula report on a monthly or quarterly basis to determine local agency usage of special or exempt formulas. • Work with support units to obtain list of participants receiving special formulas and verify proper procedures were followed. Ten (10) participants at a minimum. • Based monitoring results, determine areas of improvement in the training of staff, and clarify WIC formula policies and procedures as needed. Continue to update formula resource tables, issue timely WIC numbered memos, provide in-service training and develop user-friendly formula resources for Nutritionists. Employ multi-level approach to improve local staff and medical community knowledge in area of formula issuance. • Respond to/solicit feedback from WIC medical advisor, key stakeholders • Provide two (2) in-service trainings to identified maternity care facilities and NICU regarding WIC formula policies and procedures by September 30, 2013. Assist local agencies in providing inservice presentations as appropriate. CT WIC State Plan FY2013 Baseline June 2012 report: Exempt infant formulas Range-% Average- % Indicators Local agencies will demonstrate proficiency with: Staff assigned Nutrition Monitor Nutrition Unit Following formula policies and procedures. Appropriate rational for ordering a special formula. Local agency report of improved knowledge base and comfortlevel in interactions with HCP’s. Reduction in the number of health care provider phone calls related to confusion re: WIC special formula issuance SWIS Infant Formula Monthly Reports 67 Objective 9.2 Monitor implementation updated Nutrition Risk Criteria. Strategies/Activities By end of first quarter, review updated criteria, develop training plan and submit IT request to perform needed modifications to SWIS. Baseline Indicators IT report submitted Training scheduled for local agencies. Staff assigned Nutrition Unit Monitoring Unit Breastfeeding Unit IT Unit Monitoring results During routine monitoring local agency staff will show proficiency with providing appropriate exit counseling to participants. Nutrition Unit Monitoring Unit Breastfeeding Unit IT Unit N/A During routine monitoring local agency staff will show proficiency with implementing 1 year certification procedures. Nutrition Unit Program Monitor Breastfeeding Unit IT Unit N/A Monitor system upgrades via local agency feedback. Determine timeframe for system upgrades. Through routine monitoring determine if local staff completed required training. Plan to train appropriate WIC staff on updated risks at March Statewide meeting. Develop WIC HC Provider Fact Sheet on WHO growth standards. 9.3 100% of participants (children, postpartum and breastfeeding women) receive targeted exit counseling. 9.4 Implement 1-year certification for children. Provide tools for local agencies to educate key providers on WHO growth standards. As needed, provide targeted education to HCPs i.e. CT-AAP teleconference on adaptation of WHO growth standards. Review and update existing exit counseling policies in Local agency Policy and Procedure Manual Train local agency staff on any updated policies. Continue with implementation plan for 1 year certification for children. • Necessary changes to SWIS are completed by October 1, 2012 • Develop policy including mid-certification requirements. • At September statewide meeting, train local agency staff on 1 year certification policies and procedures CT WIC State Plan FY2013 68 Program Functional Area 10: Monitoring & QA Goal 10: Conduct on-site programmatic management and nutrition services reviews of local agencies to ensure compliance with Federal and State Regulations. Objective: 10.1 Monitor six (6) service regions including satellites. Objective: 10.2 Continue to evaluate applications of VENA principles in local operations and identify training and technical assistance needs. Objective: 10.3 Improve local agency compliance with monitoring findings (nutrition services and program operations) outcomes. Objective: 10.4 By September 30, 2013, implement a system to track, quantify and resolve vendor and participant complaints received by the State Office. Objective: 10.5 Continue implementation of off-year Local Agency Self-Assessments. Objective 10.1 Monitor six (6) service regions including satellites. Strategies/Activities • By end of 1st quarter, develop FY2013 monitoring schedule. • Conduct monitoring visits and exit conference within one (1) week of completion of fieldwork. • Prepare and submit program review reports to local agencies within thirty (30) calendar days of the last date of the program review/exit conference. • Synthesize common review findings and responses to CAP in both nutrition services and program operations to update FFY13 Goals and Objectives, training and technical assistance plans. CT WIC State Plan FY2013 Baseline FFY12 LA monitoring schedule (See Objective 10.3) Indicators FY2012 Monitoring and review schedule tracking sheet. Staff assigned Nutrition Monitor Program Monitor Number of visits and reports completed within timeframe indicated. 69 10.2 Continue to evaluate applications of VENA principles in local operations and identify training and technical assistance needs. 10.3 Continue to improve local agency compliance with monitoring findings (nutrition services and program operations) outcomes. • Use revised monitoring tools to assess/report local agency staff progress in three (3) VENA competency areas to establish individual baselines for self improvement. • Summarize collected VENA best practices in areas of nutrition services and program operations, provide to all local agencies by Sept 30 each year. Provide time at State wide meetings to highlight best practices. • Continue convene the “ReNEW 2.0 committee” as needed (every other month or quarterly) to address local agency training and technical assistance needs. -Subcommittee work to continue and evolve in FY 2013. Baselines from local agency reviews Provide targeted technical assistance interventions and training opportunities based on identified deficiencies. See attached outline of Local Agency Liaison from Nutrition Services Functional Area. Continue to use timely distribution of FAQ’s after Statewide trainings to clarify nutrition services and program operations questions. TBD Review prior monitoring reports (See Objective 10.1) Ongoing process/tool evaluation and feedback from local agencies Nutrition Unit Breastfeeding Unit Monitoring Unit Evidence of LA application of VENA principles is reflected in monitoring reports. Results of monitoring visits are incorporated into technical assistance and training plans. ReNEW 2.0 committee deliverables Reductions of repeat findings and observations in areas of nutrition services and program operations. Nutrition Unit Breastfeeding Unit Monitoring Unit As warranted, incorporate FAQ’s into Local Agency Policy and Procedure Manual CT WIC State Plan FY2013 70 10.4 By September 30, 2013, implement a system to track, quantify and resolve vendor and participant complaints received by the State Office. Review existing complain tracking procedures Based on review, refine or develop a centralized system and train appropriate State staff on how to record and track both vendor and participant complaints received by the State Office. Establish baseline. Tally number of complaints received/documented at State office Decreased number of documented complaints at the State Office Monitoring Unit Vendor Monitor Documentation of acceptable resolution of complaint(s) Update State office procedures for taking, documenting and resolving vendor complaints re: participants and participant complaints re: local agencies or vendors. During monitoring, review local agency compliance with providing required information re: WIC check use at orientation, certification and re certifications. Topics covered by local staff should include: a) Food List/WIC approved foods b) Check Redemption procedures c) Consequences of Participant abuse As needed, work with Vendor Unit to incorporate any feedback into vendor training. 10.5 Continue with implementation of offyear Local Agency Self Assessments. Provide technical assistance to the five (5) local agencies that will implement the off-year Self-Assessment. Tools and guidance available in Policy and Procedure Manual. N/A Baseline and indicators TBD. All local agencies in off-year review cycle should include one (1) page summary from SelfAssessment in FY 2014 Local Agency Plan. Nutrition Unit Breastfeeding Unit Monitoring Unit 71 CT WIC State Plan FY2013 Program Functional Area 11: Fiscal Management Goal 11: Maximize the utilization of WIC food funds. Objective: 11.1 By September 30, 2013, expand the usage to 97% of all food dollars. Objective: 11.2 By September 30, 2013, revise Local Agency forms for required monthly reporting and required budgets and local agency amendments. Objective: 11.3 By September 30, 2013, incorporate financial data into data quality activities to provide trend analysis on Connecticut WIC Objective 11.1 By September 30, 2013, expand the usage to 97% of all food dollars. Strategies/Activities Track LA expenditures monthly. • Meet with program directors. • Monitor food costs using the current CPI cost indicators. Baseline Budget/expenditure reconciliation. Indicators 100% of food dollars are accounted for. Staff Fiscal Unit 11.2 By September 30, 2013, revise Local Agency forms for required monthly reporting and required budgets and amendments. Update current forms. • Change current format to Excel. • Join worksheets to eliminate repetitive information. Worksheets with instructions for Local Agency use with fewer errors. Less time to fill out forms and cut down on errors. Fiscal Unit 11.3 By September 30, 2013, incorporate financial data into data quality activities to provide trend analysis on Connecticut WIC. Utilize financial data in trend analysis N/A Utilize financial trend data to drive program decisions Fiscal Unit CT WIC State Plan FY2013 72 Program Functional Area 12: Data Quality, Analysis & Reporting Goal 12: Strengthen data outputs for improved program planning, monitoring, evaluation and administration. Objective 12.1 Improve access to, and the utility and application of, WIC Program data: a. Build on current reports to provide enhanced, more accessible, data resources; b. Expand research/data analysis and reporting initiatives; c. Provide support in meeting other Program-related data needs. Objective 12.2 Contribute data inputs to help maximize strategic program coverage and effectiveness: a. Strengthen appropriate access to and delivery of program services; b .Ensure adequate access to vendor services, and vendor capacity to meet demand. Objective 12.1 Improve access to, and the utility and application of, WIC Program data: a. Build on current reports to provide enhanced, more accessible, data resources; Strategies/Activities Prepare summary data tables, graphs to illustrate trends, and maps to compare distribution of selected variables; CDC’s PNSS/PedNSS reports: post national, state and county data files to DPH/WIC website; share local-level files with field staff; USDA’s Program & Participant Characteristics: summarize and share pertinent information; Censor data as appropriate in keeping with confidentiality regulations prior to sharing outside of WIC Program; Post results or otherwise share selected data tables, graphs, trend reports and/or maps. Provide WIC Director with monthly summary stats covering participation, caseload, check issuance & redemption, program costs, and vendors, plus national WIC data and state population figures. CT WIC State Plan FY2013 Baseline - Monthly SWIS reports - Annual PNSS/ PedNSS reports - Biannual PC studies Indicators Enhanced analysis and data presentations better meet USDA, state & local WIC agency needs for information on: - WIC participation and caseload; - Risk factors and referrals; - Process and outcome objectives; - Check issuance and redemption; - Authorized vendors. Data tables, graphs and maps facilitate comparison of participant characteristics, risk factors, outcomes, etc.; Summary reports and improved data access result in less staff time invested in responding to routine requests. Staff Epidemiologist IT staff Nutrition unit 73 b. Expand research/data analysis and reporting initiatives; Link WIC data file with the State’s birth file & Medicaid records: determine dual enrollment WIC/Medicaid; Prior studies Project caseload, participation and program costs based on historical data and methodologies currently in use in other state WIC programs; More in-depth analyses help inform program decisions in support of key interventions and resource allocation; Local-level disparities are identified based on 2010 Census data, to better target program services & resources. Timely response to internal and external data requests; Surveys and presentations developed and/or technical assistance provided; Committees successfully complete assigned tasks. Update estimate of WIC eligible’s, using most recent Census, birth and other data sources; Epidemiologist Nutrition unit Map selected health, demographic and socioeconomic Census variables at the local level; compare results with current program coverage; Identify and track risk factors contributing to poor program outcomes; Evaluate associations between WIC participation and risk factors for poor birth outcomes. c. Provide support in meeting other Programrelated data and reporting needs. Respond to internal and external data requests; Identify/develop relevant reference & training resources; Draft presentations for WIC Director, Nutrition staff, etc. Provide survey design, analysis, reporting, or technical assistance. Collaborate in initiatives that benefit the State’s MCH population: Serve as the State’s PNSS/PedNSS Coordinator; Participate on DPH committees (MCH Block Grant, RFP and Publication Review Committees, etc.). Current SWIS reports Ongoing collaboration Epidemiologist CT WIC State Plan FY2013 74 12.2 Contribute data inputs to help maximize strategic program coverage and effectiveness: a. Strengthen appropriate access to and delivery of program services; b. Ensure adequate access to vendor services, and vendor capacity to meet demand. Monitor program services to help inform program planning and implementation efforts: - Identify service gaps, priorities and opportunities; - Track program outcomes and evaluate changes; - Target resources to improve outcomes for those at highest risk. - Provide data/mapping inputs to help: (Re)locate clinic and vendor resources; Identify specific populations to target for outreach/promotional efforts and program services. Database development: - Investigate need for data input form(s) to help facilitate data entry, increase efficiency & reduce error rates; - Continue to identify priority data needs; build standardized queries to meet those needs; - Provide monthly updates on authorized vendors to WIC Director and Vendor Management Unit. Current program services and resources Decisions to increase/decrease program services and resources are based on objective inputs; Risk factors and other variables associated with a given outcome or result are identified, providing enhanced criteria for targeting program interventions. Vendor services and resources meet participant and program needs. Epidemiologist Nutrition unit Current vendor database Currently authorized vendors Epidemiologist Vendor Unit WIC participation Vendor selection: - Review the results of upcoming policy change in vendor selection from quarterly needs assessment to open enrollment, to determine effectiveness in meeting participant and program needs. 75 CT WIC State Plan FY2013
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